Neuropsychological changes between "off" and "on" STN or GPi stimulation in Parkinson's disease
Neuropsychological changes between "off" and "on" STN or GPi stimulation in Parkinson's disease
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DOI：
10.1212/wnl.55.3.411
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发表时间：
2000-08-08
期刊：
影响因子：
9.9
通讯作者：
Agid, Y
中科院分区：
文献类型：
--
作者：
Pillon, B;Ardouin, C;Agid, Y
背景：在之前对 62 名 PD 患者进行的连续研究中，作者表明，双侧丘脑或苍白球持续高频深部脑刺激 (DBS) 在术后 3 至 6 个月内既不影响记忆也不影响执行功能。目的：通过比较刺激器“打开”和“关闭”时患者的表现来研究 DBS 的具体效果。方法：在刺激器“开启”或“关闭”的情况下，对丘脑底核（STN；n = 48）或苍白球内核（GPi；n = 8）进行 DBS 3 个月和 12 个月后，对 56 名患者执行功能临床测试的表现进行比较。在刺激器“开启”的情况下，还对整体智力效率、言语学习和情绪进行了评估。另一组 20 名患者在 STN (n = 15) 或 GPi (n = 5) 6 个月 DBS 治疗后与刺激器“打开”或“关闭”进行比较，最近的更多实验测试显示对左旋多巴治疗更敏感。结果：当刺激器“打开”时，STN 患者的精神运动速度和工作记忆表现出轻微但显着的改善。与术前状态相比，STN 患者在 12 个月时除了词汇流畅性外没有认知缺陷。 STN 或 GPi 刺激没有差异效应。结论：1）DBS 的具体效果似乎模仿左旋多巴治疗在认知和运动领域的作用； 2) 与 DBS 相关的手术似乎不会影响 PD 患者 12 个月后的认知表现，除了词汇流畅性的轻微缺陷之外。
Background: In a previous study on a consecutive series of 62 patients with PD, the authors showed that bilateral subthalamic or pallidal continuous high-frequency deep brain stimulation (DBS) affects neither memory nor executive functions 3 to 6 months after surgery. Objective: To investigate the specific effects of DBS by comparing the performance of patients with the stimulator turned "on" and "off." Methods: The performance of 56 patients on clinical tests of executive function was compared after 3 and 12 months of DBS of the subthalamic nucleus (STN; n = 48) or the internal globus pallidus (GPi; n = 8) with the stimulator "on" or "off." Global intellectual efficiency, verbal learning, and mood were also evaluated with the stimulator "on." The performance of another group of 20 patients was compared after 6 months of DBS of the STN (n = 15) or the GPi (n = 5) with the stimulator "on" or "off" on more experimental tests recently shown to be more sensitive to L-dopa therapy. Results: When the stimulator was "on," STN patients showed a mild but significant improvement in psychomotor speed and working memory. In comparison with the presurgical state, STN patients had no cognitive deficit at 12 months, except for lexical fluency. There was no differential effect of STN or GPi stimulation. Conclusions: 1) The specific effect of DBS seems to mimic the action of L-dopa treatment in the cognitive as in the motor domain; 2) the surgery associated with DBS does not appear to affect the cognitive performance of patients with PD 12 months later, except for a mild deficit in lexical fluency.