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帕金森病患者的生活质量:接受深部脑刺激治疗的患者术前和术后状态的比较。

Quality of life of patients with Parkinson's disease: a comparison between preoperative and postoperative states among those who were treated with deep brain stimulation.

机构信息

Universidade Positivo, Curitiba PR, Brazil.

Hospital Universitário Cajuru, Curitiba PR, Brazil.

出版信息

Arq Neuropsiquiatr. 2022 Apr;80(4):391-398. doi: 10.1590/0004-282X-ANP-2021-0048.

DOI:10.1590/0004-282X-ANP-2021-0048
PMID:35293555
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9173218/
Abstract

BACKGROUND

Deep brain stimulation (DBS) is a well-established procedure for treating Parkinson's disease (PD). Although its mechanisms of action are still unclear, improvements in motor symptoms and reductions in medication side effects can be achieved for a significant proportion of patients, with consequent enhancement of quality of life.

OBJECTIVE

To investigate the impact of DBS on the quality of life of PD patients.

METHODS

This was a retrospective longitudinal study with collection of historical data in a neurosurgery center, from June 2019 to December 2020. The sample was obtained according to convenience, and the Parkinson's Disease Questionnaire (PDQ-39), Unified Parkinson's Disease Rating Scale (UPDRS) III and IV, Trail-Making Test and Verbal Fluency Test were used.

RESULTS

Data were collected from 17 patients (13 with subthalamic nucleus DBS and 4 with globus pallidus pars interna DBS). Significant improvement (p=0.008) on the UPDRS III was observed in comparing the preoperative without DBS with the postoperative with DBS. About 47.0% of the patients showed post-surgical improvement in QoL (p=0.29). Thirteen patients were able to complete part A of the Trail-Making Test and four of these also completed part B. Almost 60% of the patients scored sufficiently on the semantic test, whereas only 11.8% scored sufficiently on the orthographic evaluation. No association between implant site and test performance could be traced.

CONCLUSIONS

Improvements in quality of life and motor function were observed in the majority of the patients enrolled. Despite the limitations of this study, DBS strongly benefits a significant proportion of PD patients when well indicated.

摘要

背景

深部脑刺激(DBS)是一种治疗帕金森病(PD)的成熟方法。尽管其作用机制仍不清楚,但对很大一部分患者可以实现运动症状的改善和药物副作用的减少,从而提高生活质量。

目的

探讨 DBS 对 PD 患者生活质量的影响。

方法

这是一项回顾性纵向研究,于 2019 年 6 月至 2020 年 12 月在神经外科中心收集历史数据。根据方便原则抽取样本,使用帕金森病问卷(PDQ-39)、统一帕金森病评定量表(UPDRS)III 和 IV、连线测试和词语流畅性测试。

结果

共收集了 17 名患者(13 名接受丘脑底核 DBS,4 名接受苍白球内侧部 DBS)的数据。与术前无 DBS 相比,术后 DBS 时 UPDRS III 显著改善(p=0.008)。约 47.0%的患者术后生活质量(QoL)改善(p=0.29)。13 名患者能够完成连线测试 A 部分,其中 4 名也完成了 B 部分。近 60%的患者语义测试得分足够,而只有 11.8%的患者在正字法评估中得分足够。未发现植入部位与测试表现之间存在关联。

结论

大多数入组患者的生活质量和运动功能均得到改善。尽管存在研究局限性,但 DBS 在适应证明确的情况下对相当一部分 PD 患者有显著益处。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f5a/9173218/eee3ebc2423d/1678-4227-anp-80-4-0048-gf02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f5a/9173218/69401cf2f49d/1678-4227-anp-80-4-0048-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f5a/9173218/eee3ebc2423d/1678-4227-anp-80-4-0048-gf02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f5a/9173218/69401cf2f49d/1678-4227-anp-80-4-0048-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f5a/9173218/eee3ebc2423d/1678-4227-anp-80-4-0048-gf02.jpg

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本文引用的文献

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Parkinson's disease motor subtypes and bilateral GPi deep brain stimulation: One-year outcomes.帕金森病运动亚型与双侧苍白球内侧部脑深部电刺激:一年随访结果。
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Comparison of Efficacy of Deep Brain Stimulation of Different Targets in Parkinson's Disease: A Network Meta-Analysis.帕金森病不同靶点深部脑刺激疗效的比较:一项网状Meta分析
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The long-term efficacy of STN vs GPi deep brain stimulation for Parkinson disease: A meta-analysis.
丘脑底核与苍白球内侧部脑深部电刺激治疗帕金森病的长期疗效:一项荟萃分析。
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Neurosurgery. 2019 Sep 1;85(3):343-349. doi: 10.1093/neuros/nyy287.
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Short-term quality of life after subthalamic stimulation depends on non-motor symptoms in Parkinson's disease.帕金森病患者丘脑底核刺激术后短期生活质量与非运动症状相关。
Brain Stimul. 2018 Jul-Aug;11(4):867-874. doi: 10.1016/j.brs.2018.02.015. Epub 2018 Feb 24.
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Long-Term Satisfaction and Patient-Centered Outcomes of Deep Brain Stimulation in Parkinson's Disease.帕金森病深部脑刺激的长期满意度和以患者为中心的结果
Brain Sci. 2018 Apr 1;8(4):60. doi: 10.3390/brainsci8040060.
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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary.美国神经外科学院系统评价和循证临床实践指南:丘脑底核和苍白球内侧部脑深部电刺激治疗帕金森病患者的临床实践指南:执行摘要。
Neurosurgery. 2018 Jun 1;82(6):753-756. doi: 10.1093/neuros/nyy037.
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Deep Brain Stimulation of the Subthalamic Nucleus and Globus Pallidus for Parkinson's Disease.帕金森病的丘脑底核和苍白球内侧部深部脑刺激术
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