丘脑底核深部脑刺激治疗晚期帕金森病的双盲评估

Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's disease.

作者信息

Kumar R, Lozano A M, Kim Y J, Hutchison W D, Sime E, Halket E, Lang A E

机构信息

Division of Neurology, Faculty of Medicine, University of Toronto, Canada.

出版信息

Neurology. 1998 Sep;51(3):850-5. doi: 10.1212/wnl.51.3.850.

DOI:10.1212/wnl.51.3.850

PMID:9748038

Abstract

OBJECTIVE

To examine objectively the clinical effects of subthalamic nucleus (STN) deep brain stimulation (DBS) in advanced PD.

METHODS

Our initial seven consecutive patients with medication-refractory motor fluctuations and levodopa-induced dyskinesias undergoing chronic STN DBS underwent a standardized preoperative evaluation followed by a 2-day double-blind evaluation of efficacy 6 to 12 months after electrode implantation. Diaries documenting motor fluctuations and dyskinesias were also completed preoperatively and postoperatively.

RESULTS

In the medication-off state, turning the stimulators on resulted in improvement in mean total Unified Parkinson's Disease Rating Scale (UPDRS) motor score by 58% including the following improvements in composite scores: akinesia 57%, rigidity 52%, tremor 82%, and gait and postural stability 49%. Additionally, the medication-off state improved 17% without stimulation, possibly as a result of electrode insertion alone or carry-over of chronic stimulation. In the medication-on, stimulation-on state, all major features of parkinsonism improved and total UPDRS motor score improved 41% compared with before surgery. Activities of daily living were improved while off medication 30%, and levodopa-induced dyskinesias were reduced 83% while total drug dosage was decreased 40%. With chronic stimulation, patients reported that the percentage of time spent in the "on" state (without dyskinesias) increased from 26% to 52% and "off" time decreased from 30% to 6%. Operative complications including cognitive worsening were not uncommon.

CONCLUSIONS

STN DBS is a promising new surgical option for the treatment of advanced PD. The marked clinical benefits obtained in these severely disabled patients outweighed the adverse effects.

摘要

目的

客观评估丘脑底核（STN）深部脑刺激（DBS）治疗晚期帕金森病（PD）的临床效果。

方法

我们最初的7例连续患者，均为药物难治性运动波动和左旋多巴诱导的异动症患者，接受了慢性STN-DBS治疗。这些患者在术前接受了标准化评估，然后在电极植入后6至12个月进行了为期2天的双盲疗效评估。术前和术后还完成了记录运动波动和异动症的日记。

结果

在关药状态下，打开刺激器可使统一帕金森病评定量表（UPDRS）运动总分平均改善58%，其中各分项得分改善情况如下：运动不能57%、强直52%、震颤82%、步态和姿势稳定性49%。此外，在未进行刺激的情况下，关药状态也改善了17%，这可能是由于单纯电极插入或慢性刺激的延续效应所致。在开药且开启刺激的状态下，帕金森病的所有主要特征均得到改善，与手术前相比，UPDRS运动总分改善了41%。非药物状态下日常生活活动能力改善了30%，左旋多巴诱导的异动症减少了83%，同时药物总剂量减少了40%。长期刺激后，患者报告处于“开”状态（无异动症）的时间百分比从26%增加到52%，“关”状态时间从30%减少到6%。包括认知功能恶化在内的手术并发症并不少见。