Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China.
China Medical University, Shenyang, China.
CNS Neurosci Ther. 2024 Aug;30(8):e14899. doi: 10.1111/cns.14899.
Deep brain stimulation (DBS) is not routinely performed in elderly patients (≥75 years old) to date because of concerns about complications and decreased benefit. This study aimed to evaluate the safety and efficacy of DBS in elderly patients with Parkinson's disease.
A retrospective analysis was performed using data from 40 elderly patients from four centers who were treated with neurosurgical robot-assisted DBS between September 2016 and December 2021. These patients were followed up for a minimum period of 2 years, with a subgroup of nine patients followed up for 5-7 years. Patient demographic characteristics, surgical information, pre- and postoperative motor scores, non-motor scores, activities of daily living, and complications were retrospectively analyzed.
The mean surgical procedure duration was 1.65 ± 0.24 h, with a mean electrode implantation duration of 1.10 ± 0.23 h and a mean pulse generator implantation duration of 0.55 ± 0.07 h. The mean pneumocephalus volume, electrode fusion error, and Tao's DBS surgery scale were 16.23 ± 12.81 cm, 0.81 ± 0.23 mm, and 77.63 ± 8.08, respectively. One patient developed a skin infection, and the device was removed. The Unified Parkinson's disease rating scale, Unified Parkinson's disease rating scale of Part III, tremor, rigidity, bradykinesia, axial, and Barthel index for activities of daily living (ADL-Barthel) scores significantly improved at the 2-year follow-up (p < 0.05). The levodopa equivalent daily dose (LEDD) was significantly reduced at the 2-year follow-up (p < 0.05). However, the Montreal cognitive assessment, Hamilton depression scale, and Hamilton anxiety scale scores did not significantly change during the 2-year follow-up (p > 0.05). Additionally, in the subgroup with a 5-year follow-up, the motor symptoms, ADL-Barthel score, and cognitive function worsened over time compared to baseline. However, there was still an improvement in motor symptoms and ADL with DBS on-stimulation compared with the off-stimulation state. The LEDD increased 5 years after surgery compared to that at baseline. Eleven patients had passed away during follow-up, the mean survival time was 38.3 ± 17.3 months after surgery, and the mean age at the time of death was 81.2 (range 75-87) years.
Robot-assisted DBS surgery for the elderly patients with Parkinson's disease is accurate and safe. Motor symptoms and ADL significantly improve and patients can benefit from long-term neuromodulation, which may decrease the risk of death.
目前，深部脑刺激（DBS）尚未常规应用于老年患者（≥75 岁），因为担心并发症和获益减少。本研究旨在评估 DBS 治疗帕金森病老年患者的安全性和有效性。
使用来自四个中心的 40 名老年患者的数据进行回顾性分析，这些患者于 2016 年 9 月至 2021 年 12 月期间接受神经外科机器人辅助 DBS 治疗。这些患者的随访时间至少为 2 年，其中 9 名患者的亚组随访时间为 5-7 年。回顾性分析患者的人口统计学特征、手术信息、术前和术后运动评分、非运动评分、日常生活活动能力和并发症。
手术平均持续时间为 1.65±0.24 小时，电极植入平均持续时间为 1.10±0.23 小时，脉冲发生器植入平均持续时间为 0.55±0.07 小时。平均气颅体积、电极融合误差和 Tao 的 DBS 手术量表分别为 16.23±12.81cm³、0.81±0.23mm 和 77.63±8.08。1 名患者发生皮肤感染，设备被取出。在 2 年随访时，帕金森病统一评分量表、帕金森病统一评分量表第三部分、震颤、僵硬、运动迟缓、轴性和日常生活活动能力（ADL-Barthel）Barthel 指数评分显著改善（p<0.05）。在 2 年随访时，左旋多巴等效日剂量（LEDD）显著降低（p<0.05）。然而，在 2 年随访期间，蒙特利尔认知评估量表、汉密尔顿抑郁量表和汉密尔顿焦虑量表评分没有显著变化（p>0.05）。此外，在 5 年随访的亚组中，与基线相比，运动症状、ADL-Barthel 评分和认知功能随时间恶化。然而，与关闭刺激状态相比，DBS 刺激仍能改善运动症状和 ADL。术后 5 年，LEDD 较基线升高。11 名患者在随访期间死亡，术后平均生存时间为 38.3±17.3 个月，死亡时的平均年龄为 81.2（75-87 岁）岁。
机器人辅助 DBS 手术治疗帕金森病老年患者安全准确。运动症状和 ADL 显著改善，患者可从长期神经调节中获益，这可能降低死亡风险。
