Brozova Hana, Barnaure Isabelle, Ruzicka Evzen, Stochl Jan, Alterman Ron, Tagliati Michele
Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.
Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland.
Front Neurol. 2021 Oct 8;12:688760. doi: 10.3389/fneur.2021.688760. eCollection 2021.
The aim was to compare the short and long-term effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on gait dysfunction and other cardinal symptoms of Parkinson's disease (PD). Two groups of patients were studied. The first group (short-term DBS, = 8) included patients recently implanted with STN DBS (mean time since DBS 15.8 months, mean age 58.8 years, PD duration 13 years); the second group (long-term DBS, = 10) included patients with at least 5 years of DBS therapy (mean time since DBS 67.6 months, mean age 61.7 years, PD duration 17.1 years). Both groups were examined using the Unified Parkinson's Disease Rating Scale (UPDRS) and Gait and Balance scale (GABS) during four stimulation/medication states (ON/OFF; OFF/OFF; OFF/ON; ON/ON). Data were analyzed using repeated measures ANOVA with time since implantation (years) between groups and medication or DBS effect (ON, OFF) within groups. In the short-term DBS group, stimulation improved all UPDRS subscores similar to dopaminergic medications. In particular, average gait improvement was over 40% ( = 0.01), as measured by the UPDRS item 29 and GABS II. In the long-term DBS group, stimulation consistently improved all clinical subscores with the exception of gait and postural instability. In these patients, the effect of levodopa on gait was partially preserved. Short-term improvement of gait abnormalities appears to significantly decline after 5 years of STN DBS in PD patients, while effectiveness for other symptoms remains stable. Progressive non-dopaminergic (non-DBS responsive) mechanisms or deleterious effects of high frequency STN stimulation on gait function may play a role.
目的是比较丘脑底核（STN）深部脑刺激（DBS）对帕金森病（PD）步态功能障碍和其他主要症状的短期和长期影响。研究了两组患者。第一组（短期DBS，n = 8）包括最近植入STN DBS的患者（自DBS以来的平均时间为15.8个月，平均年龄58.8岁，PD病程13年）；第二组（长期DBS，n = 10）包括接受至少5年DBS治疗的患者（自DBS以来的平均时间为67.6个月，平均年龄61.7岁，PD病程17.1年）。两组患者在四种刺激/用药状态（开/关；关/关；关/开；开/开）下使用统一帕金森病评定量表（UPDRS）和步态与平衡量表（GABS）进行检查。使用重复测量方差分析对数据进行分析，分析组间植入后时间（年）以及组内用药或DBS效应（开、关）。在短期DBS组中，刺激改善了所有UPDRS子评分，类似于多巴胺能药物。特别是，根据UPDRS第29项和GABS II测量，平均步态改善超过40%（P = 0.01）。在长期DBS组中，除步态和姿势不稳外，刺激持续改善了所有临床子评分。在这些患者中，左旋多巴对步态的影响部分得以保留。PD患者接受STN DBS 5年后，步态异常的短期改善似乎显著下降，而对其他症状的有效性保持稳定。渐进性非多巴胺能（非DBS反应性）机制或高频STN刺激对步态功能的有害影响可能起了作用。
