Guidetti M, Marceglia S, Bocci T, Duncan R, Fasano A, Foote K D, Hamani C, Krauss J K, Kühn A A, Lena F, Limousin P, Lozano A M, Maiorana N V, Modugno N, Moro E, Okun M S, Oliveri S, Santilli M, Schnitzler A, Temel Y, Timmermann L, Visser-Vandewalle V, Volkmann J, Priori A
"Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy.
Clinical Neurology Unit, "Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo", Department of Health Sciences, University of Milan, Via Antonio di Rudinì 8, 20142 Milan, Italy.
medRxiv. 2024 Sep 23:2024.09.20.24314037. doi: 10.1101/2024.09.20.24314037.
Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinson's disease (PwPD), the size and duration of the effects of STN-DBS on motor axial (e.g., postural instability, trunk posture alterations) and gait impairments (e.g., freezing of gait - FOG) are still ambiguous. Physical therapy (PT) effectively complements pharmacological treatment to improve postural stability, gait performance, and other dopamine-resistant symptoms (e.g. festination, hesitation, axial motor dysfunctions, and FOG) in PwPD who are non-surgically treated. Despite the potential for positive adjuvant effects of PT following STN-DBS surgery, there is a paucity of science available on the topic. In such a scenario, gathering the opinion and expertise of leading investigators worldwide was pursued to study motor rehabilitation in PwPD following STN-DBS. After summarizing the few available findings through a systematic review, we identified clinical and academically experienced DBS clinicians (n=21) to discuss the challenges related to PT following STN-DBS. A 5-point Likert scale questionnaire was used and based on the results of the systematic review along with a Delphi method. Thirty-nine questions were submitted to the panel - half related to general considerations on PT following STN-DBS, half related to PT treatments. Despite the low-to-moderate quality, the few available rehabilitative studies suggested that PT could improve dynamic and static balance, gait performance and posture. Similarly, panellists strongly agreed that PT might help in improving motor symptoms and quality of life, and it may be possibly prescribed to maximize the effects of the stimulation. The experts agreed that physical therapists could be part of the multidisciplinary team taking care of the patients. Also, they agreed on prescribing of conventional PT, but not massage or manual therapy. Our results will inform the rehabilitation and the DBS community to engage, publish and deepen this area of research. Such efforts may spark guidelines for PT following STN-DBS.
尽管对丘脑底核进行深部脑刺激（STN-DBS）可使帕金森病患者（PwPD）获得运动益处，但STN-DBS对运动轴性症状（如姿势不稳、躯干姿势改变）和步态障碍（如步态冻结 - FOG）影响的程度和持续时间仍不明确。物理治疗（PT）可有效辅助药物治疗，改善非手术治疗的PwPD患者的姿势稳定性、步态表现及其他对多巴胺耐药的症状（如慌张步态、步态踌躇、轴性运动功能障碍和FOG）。尽管STN-DBS手术后PT可能具有积极的辅助作用，但关于该主题的科学研究却很少。在这种情况下，我们收集了全球主要研究者的意见和专业知识，以研究STN-DBS术后PwPD患者的运动康复情况。通过系统综述总结了少数现有研究结果后，我们确定了21名具有临床和学术经验的DBS临床医生，讨论STN-DBS术后与PT相关的挑战。采用了5级李克特量表问卷，并基于系统综述结果及德尔菲法。向专家小组提出了39个问题，其中一半与STN-DBS术后PT的一般考虑有关，另一半与PT治疗有关。尽管现有康复研究质量为低到中等，但少数研究表明PT可改善动态和静态平衡、步态表现和姿势。同样，专家小组成员强烈认为PT可能有助于改善运动症状和生活质量，并且可能会被处方以最大化刺激效果。专家们一致认为物理治疗师可以成为照顾患者的多学科团队的一部分。此外，他们同意采用传统PT治疗，但不包括按摩或手法治疗。我们的研究结果将为康复和DBS领域提供参考，以促进该领域的研究、发表和深入探讨。这些努力可能会催生STN-DBS术后PT的指导原则。
