Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues.
Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues.
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DOI：
10.1001/archneurol.2010.260
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发表时间：
2011-02
影响因子：
--
通讯作者：
DeLong MR
中科院分区：
文献类型：
--
作者：
Bronstein JM;Tagliati M;Alterman RL;Lozano AM;Volkmann J;Stefani A;Horak FB;Okun MS;Foote KD;Krack P;Pahwa R;Henderson JM;Hariz MI;Bakay RA;Rezai A;Marks WJ Jr;Moro E;Vitek JL;Weaver FM;Gross RE;DeLong MR
就涉及脑深部电刺激（DBS）治疗帕金森病（PD）的几个问题向患者、医生和其他医疗保健提供者提供建议。一个国际专家联合会组织、审查了文献并出席了讲习班。在讲习班上介绍了专题，然后进行了小组讨论。会上提出了一份协商一致声明草案，并在全体辩论后作了进一步编辑。所有成员商定了最后发言。(1)没有明显的主动认知或精神问题的PD患者，如果有医学上难治性运动波动、难治性震颤或对药物不良反应不耐受，则是DBS的良好候选者。(2)脑深部电刺激手术最好由具有立体定向神经外科专业知识的经验丰富的神经外科医生进行，他们是跨专业团队的一部分。(3)手术并发症发生率差异极大，感染是DBS最常报告的并发症。(4)脑深部电刺激编程最好由训练有素的临床医生完成，可能需要3到6个月才能获得最佳结果。(5)脑深部电刺激改善左旋多巴反应症状、运动障碍和震颤;在许多运动领域，益处似乎是持久的。(6)在一部分患者中，丘脑底核DBS可能并发抑郁、冷漠、冲动、语言流畅性恶化和执行功能障碍。(7)苍白球内侧部和丘脑底核DBS均已被证明可有效解决PD的运动症状。(8)消融治疗仍然是一种有效的替代方法，应在选定的适当患者组中考虑。
To provide recommendations to patients, physicians, and other health care providers on several issues involving deep brain stimulation (DBS) for Parkinson disease (PD). An international consortium of experts organized, reviewed the literature, and attended the workshop. Topics were introduced at the workshop, followed by group discussion. A draft of a consensus statement was presented and further edited after plenary debate. The final statements were agreed on by all members. (1) Patients with PD without significant active cognitive or psychiatric problems who have medically intractable motor fluctuations, intractable tremor, or intolerance of medication adverse effects are good candidates for DBS. (2) Deep brain stimulation surgery is best performed by an experienced neurosurgeon with expertise in stereotactic neurosurgery who is working as part of a interprofessional team. (3) Surgical complication rates are extremely variable, with infection being the most commonly reported complication of DBS. (4) Deep brain stimulation programming is best accomplished by a highly trained clinician and can take 3 to 6 months to obtain optimal results. (5) Deep brain stimulation improves levodopa-responsive symptoms, dyskinesia, and tremor; benefits seem to be long-lasting in many motor domains. (6) Subthalamic nuclei DBS may be complicated by increased depression, apathy, impulsivity, worsened verbal fluency, and executive dysfunction in a subset of patients. (7) Both globus pallidus pars interna and subthalamic nuclei DBS have been shown to be effective in addressing the motor symptoms of PD. (8) Ablative therapy is still an effective alternative and should be considered in a select group of appropriate patients.