NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal; Neurology Department, Centre Hospitalier Universitaire Toulouse, place du Dr Baylac, TSA 40031, 31059, Toulouse, France; Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, R. da Junqueira 126, 1349-019, Lisboa, Portugal.
Neurology Department, Department of Neurosciences and Mental Health, Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal; Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal.
Parkinsonism Relat Disord. 2024 Jan;118:105921. doi: 10.1016/j.parkreldis.2023.105921. Epub 2023 Nov 11.
Data on the long-term survival and incidence of disability milestones after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) is limited.
To estimate mortality and assess the frequency/time-to-development of disability milestones (falls, freezing, hallucinations, dementia, and institutionalization) among PD patients post STN-DBS.
A longitudinal retrospective study of patients undergoing STN-DBS. For mortality, Cox proportional hazards regression analysis was performed. For disease milestones, competing risk analyses were performed and cumulative incidence functions reported. The strength of association between baselines features and event occurrence was calculated based on adjusted hazard ratios.
The overall mortality for the 109 patients was 16 % (62.1 ± 21.3 months after surgery). Falls (73 %) and freezing (47 %) were both the earliest (40.4 ± 25.4 and 39.6 ± 28.4 months, respectively) and most frequent milestones. Dementia (34 %) and hallucinations (32 %) soon followed (56.2 ± 21.2 and mean 60.0 ± 20.7 months after surgery, respectively). Higher ADL scores in the OFF state and higher age at surgery were associated with falls, freezing, dementia and institutionalization.
Long-term mortality rate is low after STN-DBS. Disease milestones occur later during the disease course, with motor milestones appearing first and at a higher frequency than cognitive ones.
关于丘脑底核深部脑刺激（STN-DBS）后帕金森病（PD）患者长期生存和残疾里程碑发生率的数据有限。
评估 STN-DBS 后 PD 患者的死亡率，并评估残疾里程碑（跌倒、冻结、幻觉、痴呆和住院）的发生频率/时间。
对接受 STN-DBS 的患者进行了一项纵向回顾性研究。对于死亡率，进行了 Cox 比例风险回归分析。对于疾病里程碑，进行了竞争风险分析，并报告了累积发生率函数。基于调整后的危险比，计算了基线特征与事件发生之间的关联强度。
109 例患者的总死亡率为 16%（术后 62.1±21.3 个月）。跌倒（73%）和冻结（47%）都是最早（分别为 40.4±25.4 和 39.6±28.4 个月）和最常见的里程碑。痴呆（34%）和幻觉（32%）紧随其后（分别为术后 56.2±21.2 和平均 60.0±20.7 个月）。在关闭状态下 ADL 评分较高和手术时年龄较大与跌倒、冻结、痴呆和住院有关。
STN-DBS 后长期死亡率较低。疾病里程碑在疾病过程中出现较晚，运动里程碑出现的频率更高，且早于认知里程碑。
