Neurology Unit, IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Department of Neurology, The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, New York, NY, USA.
Neurol Sci. 2024 Feb;45(2):565-572. doi: 10.1007/s10072-023-07059-2. Epub 2023 Sep 12.
Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is standard of care for Parkinson's disease (PD) patients and a correct lead placement is crucial to obtain good clinical outcomes. Evidence demonstrating the targeting accuracy of the frameless technique for DBS, along with the advantages for patients and clinicians, is solid, while data reporting long-term clinical outcomes for PD patients are still lacking.
The study aims to assess the clinical safety and efficacy of frameless bilateral STN-DBS in PD patients at 5 years from surgery.
Consecutive PD patients undergoing bilateral STN-DBS with a frameless system were included in this single-center retrospective study. Clinical features, including the Unified Parkinson's Disease Rating Scale (UPDRS) in its total motor score and axial sub-scores, and pharmacological regimen were assessed at baseline, 1 year, 3 years, and 5 years after surgery. The adverse events related to the procedure, stimulation, or the presence of the hardware were systematically collected.
Forty-one PD patients undergone bilateral STN-DBS implantation were included in the study and fifteen patients already completed the 5-year observation. No complications occurred during surgery and the perioperative phase, and no unexpected serious adverse event occurred during the entire follow-up period. At 5 years from surgery, there was a sustained motor efficacy of STN stimulation: STN-DBS significantly improved the off-stim UPDRS III score at 5 years by 37.6% (P < 0.001), while the dopaminergic medications remained significantly reduced compared to baseline (- 21.6% versus baseline LEDD; P = 0.036).
Our data support the use of the frameless system for STN-DBS in PD patients, as a safe and well-tolerated technique, with long-term clinical benefits and persistent motor efficacy at 5 years from the surgery.
双侧丘脑底核（STN）脑深部电刺激（DBS）是治疗帕金森病（PD）的标准方法，正确的导联放置对于获得良好的临床效果至关重要。无框架技术在 DBS 中的靶向准确性的证据，以及对患者和临床医生的优势，是确凿的，而报告 PD 患者长期临床结果的数据仍然缺乏。
本研究旨在评估无框架双侧 STN-DBS 在术后 5 年时对 PD 患者的临床安全性和疗效。
本单中心回顾性研究纳入了接受无框架系统双侧 STN-DBS 的连续 PD 患者。在手术前、手术后 1 年、3 年和 5 年时，评估了临床特征，包括帕金森病评定量表（UPDRS）的总运动评分和轴性亚评分，以及药物治疗方案。系统收集了与手术、刺激或硬件有关的不良事件。
本研究纳入了 41 例接受双侧 STN-DBS 植入的 PD 患者，其中 15 例患者已经完成了 5 年的观察。手术和围手术期无并发症，整个随访期间无意外严重不良事件发生。术后 5 年，STN 刺激的运动疗效持续：STN-DBS 在 5 年内显著改善了关期 UPDRS III 评分（P<0.001），而与基线相比，多巴胺能药物的用量仍显著减少（与基线相比，减少了 21.6%；P=0.036）。
我们的数据支持在 PD 患者中使用无框架系统进行 STN-DBS，这是一种安全且耐受良好的技术，具有长期的临床益处和持久的运动疗效，在手术后 5 年仍有效。
