Measures of impulsivity in Parkinson's disease decrease after DBS in the setting of stable dopamine therapy.
Measures of impulsivity in Parkinson's disease decrease after DBS in the setting of stable dopamine therapy.
复制标题
在稳定多巴胺治疗的情况下，DBS 治疗后帕金森病的冲动性指标有所下降。
DOI：
10.1016/j.parkreldis.2017.08.006
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发表时间：
2017
影响因子：
4.1
通讯作者：
Okun,MichaelS
中科院分区：
文献类型：
--
作者：
Rossi,PJustin;DeJesus,Sol;Hess,ChristopherW;Martinez-Ramirez,Daniel;Foote,KellyD;Gunduz,Aysegul;Okun,MichaelS
最近的证据表明，脑深部电刺激可以改变冲动控制。我们的目的是前瞻性地评估在保守的多巴胺减少策略的情况下，丘脑底核（subthalamic nucleus，简称STN）和苍白球内侧（globus pallidus internus，简称GPi）脑深部电刺激对冲动控制障碍（impulse control disorders，简称ICD）的影响。在术前和术后6-12个月对单侧DBS或GPi DBS电极导线植入进行评价，手术ICD的存在下，使用帕金森氏病的冲动问卷（QUIP）和临床interview.ResultsOf患者登记，23例进行电极植入苍白球内，14例植入丘脑底核。至长期随访的平均时间为9.7 ± 2.4个月。术后LEDD未显著低于术前LEDD（术前：1238.53 ± 128.47 vs.术后：1178.18 ± 126.43，p = 0.2972，配对检验）。随访时的平均QUIP评分显著低于术前基线（1.51 ± 0.45 vs. 2.51 ± 0.58，p = 0.0447，配对检验）。术前植入ICD的患者（n = 14，37.8%）在随访时QUIP评分显著改善（6.00 ± 0.94 vs. 2.64 ± 0.98，p = 0.0014，配对检验）。改善是不统一的整个队列：1例患者ICD在基线症状恶化，4例患者术前无ICD开发临床显着的ICD postoperatives.ConclusionWhen LEDD是相对不变的PD后，DBS或GPi，ICD症状趋于改善，虽然恶化和出现新的ICD可以发生。在稳定的LEDD的设置，这些研究结果表明，DBS的内在效应可能在改变冲动行为中发挥重要作用。
IntroductionRecent evidence suggests deep brain stimulation can alter impulse control. Our objective was to prospectively evaluate the effects of subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation on impulse control disorders (ICDs) in the setting of a conservative dopamine reduction strategy.MethodsPatients (n = 37) undergoing de novo, unilateral STN or GPi DBS lead implantation were evaluated pre-operatively and 6–12 months post-operatively for the presence of ICDs using the Questionnaire for Impulsivity in Parkinson's disease (QUIP) and by clinical interview.ResultsOf the patients enrolled, 23 underwent electrode implantation in the globus pallidus internus and 14 were implanted in the subthalamic nucleus. Mean time to long term follow-up was 9.7 ± 2.4 months. Post-operative LEDD was not significantly lower than pre-operative LEDD (pre-op: 1238.53 ± 128.47 vs. post-op: 1178.18 ± 126.43, p = 0.2972, pairedt-test). Mean QUIP scores were significantly lower at follow up compared to pre-operative baseline (1.51 ± 0.45 vs. 2.51 ± 0.58,p= 0.0447, pairedt-test). Patients with ICDs pre-operatively (n = 14, 37.8%) had significant improvement in QUIP scores at follow-up (6.00 ± 0.94 vs. 2.64 ± 0.98,p= 0.0014, pairedt-test). Improvement was not uniform across the cohort: 1 patient with ICD at baseline developed worsening symptoms, and 4 patients with no ICD pre-operatively developed clinically significant ICDs post-operatively.ConclusionWhen LEDD is relatively unchanged following STN or GPi DBS for PD, ICD symptoms tend toward improvement, although worsening and emergence of new ICDs can occur. In the setting of stable LEDD, these findings suggest that the intrinsic effects of DBS may play a significant role in altering impulsive behavior.