Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Mov Disord. 2022 Aug;37(8):1581-1592. doi: 10.1002/mds.29052. Epub 2022 May 12.
A robust body of evidence from randomized controlled trials has established the efficacy of deep brain stimulation (DBS) in reducing off time and dyskinesias in levodopa-treated patients with Parkinson's disease (PD). These effects go along with improvements in on period motor function, activities of daily living, and quality of life. In addition, subthalamic DBS is effective in controlling drug-refractory PD tremor. Here, we review the available data from long-term observational and controlled follow-up studies in DBS-treated patients to re-examine the persistence of motor and quality of life benefits and evaluate the effects on disease progression, major disability milestones, and survival. Although there is consistent evidence from observational follow-up studies in DBS-treated patients over 5-10 years and beyond showing sustained improvement of motor control, the long-term impact of DBS on overall progression of disability in PD is less clear. Whether DBS reduces or delays the development of later motor and non-motor disability milestones in comparison to best medical management strategies is difficult to answer by uncontrolled observational follow-up, but there are signals from controlled long-term observational studies suggesting that subthalamic DBS may delay some of the late-stage disability milestones including psychosis, falls, and institutionalization, and also slightly prolongs survival compared with matched medically managed patients. These observations could be attributable to the sustained improvements in motor function and reduction in medication-induced side effects, whereas there is no clinical evidence of direct effects of DBS on the underlying disease progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
大量随机对照试验的证据已经证实，深部脑刺激（DBS）可有效减少左旋多巴治疗的帕金森病（PD）患者的关期时间和运动障碍。这些效果伴随着运动功能、日常生活活动和生活质量的改善。此外，丘脑下核 DBS 对控制药物难治性 PD 震颤有效。在这里，我们回顾了 DBS 治疗患者的长期观察性和对照随访研究中的现有数据，重新检查运动和生活质量获益的持续性，并评估其对疾病进展、主要残疾里程碑和生存的影响。尽管有来自 DBS 治疗患者的 5-10 年及以上的观察性随访研究的一致证据表明运动控制持续改善，但 DBS 对 PD 整体残疾进展的长期影响尚不清楚。与最佳药物治疗策略相比，DBS 是否能减少或延迟后期运动和非运动残疾里程碑的发展，通过未受控制的观察性随访难以回答，但有来自对照长期观察性研究的信号表明，丘脑下核 DBS 可能延迟一些晚期残疾里程碑，包括精神病、跌倒和住院，并且与匹配的药物治疗患者相比，寿命也略有延长。这些观察结果可能归因于运动功能的持续改善和药物引起的副作用减少，而没有 DBS 对潜在疾病进展的直接影响的临床证据。© 2022 作者。运动障碍由 Wiley Periodicals LLC 代表国际帕金森和运动障碍协会出版。
