探讨帕金森病慢性深部脑刺激前后的心血管自主功能。
Exploring Cardiovascular Autonomic Function before and after Chronic Deep Brain Stimulation in Parkinson's Disease.
机构信息
Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum-University of Bologna, Bologna, Italy.
IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
出版信息
Mov Disord Clin Pract. 2024 Jun;11(6):698-703. doi: 10.1002/mdc3.14060. Epub 2024 May 2.
BACKGROUND
Blood pressure control in Parkinson's disease (PD) under subthalamic deep brain stimulation (STN-DBS) is influenced by several intertwined aspects, including autonomic failure and levodopa treatment.
OBJECTIVE
To evaluate the effect of chronic STN-DBS, levodopa, and their combination on cardiovascular autonomic functions in PD.
METHODS
We performed cardiovascular reflex tests (CRTs) before and 6-months after STN-DBS surgery in 20 PD patients (pre-DBS vs. post-DBS). CRTs were executed without and with medication (med-OFF vs. med-ON).
RESULTS
CRT results and occurrence of neurogenic orthostatic hypotension (OH) did not differ between pre- and post-DBS studies in med-OFF condition. After levodopa intake, the BP decrease during HUTT was significantly greater compared to med-OFF, both at pre-DBS and post-DBS evaluation. Levodopa-induced OH was documented in 25% and 5% of patients in pre-DBS/med-ON and post-DBS/med-ON study.
CONCLUSION
Chronic stimulation did not influence cardiovascular responses, while levodopa exerts a relevant hypotensive effect. The proportion of patients presenting levodopa-induced OH decreases after STN-DBS surgery.
背景
在丘脑底核深部脑刺激（STN-DBS）下，帕金森病（PD）的血压控制受到多个相互交织的方面的影响，包括自主神经衰竭和左旋多巴治疗。
目的
评估慢性 STN-DBS、左旋多巴及其联合治疗对 PD 患者心血管自主功能的影响。
方法
我们对 20 名 PD 患者在 STN-DBS 手术前（术前）和 6 个月后（术后）进行了心血管反射测试（CRT）。CRTs 在不服用药物（med-OFF）和服用药物（med-ON）两种情况下进行。
结果
med-OFF 条件下，CRT 结果和神经源性直立性低血压（OH）的发生在术前和术后研究中没有差异。与 med-OFF 相比，左旋多巴摄入后，HUTT 期间的血压下降在术前和术后评估中均显著更大。在术前/med-ON 和术后/med-ON 研究中，分别有 25%和 5%的患者出现了左旋多巴诱导的 OH。
结论
慢性刺激不会影响心血管反应，而左旋多巴则产生明显的降压作用。STN-DBS 手术后，出现左旋多巴诱导的 OH 的患者比例下降。
Zotero 插件