Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences.
Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences.
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DOI：
10.1371/journal.pone.0178984
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Hamel W
中科院分区：
文献类型：
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作者：
Buhmann C;Huckhagel T;Engel K;Gulberti A;Hidding U;Poetter-Nerger M;Goerendt I;Ludewig P;Braass H;Choe CU;Krajewski K;Oehlwein C;Mittmann K;Engel AK;Gerloff C;Westphal M;Köppen JA;Moll CKE;Hamel W
深部脑刺激 (DBS) 改善生活质量的程度可能被视为神经系统改善与治疗并发症、合并症和疾病进展之间的永久权衡。我们回顾性调查了 123 名连续的和非预选的患者。 DBS 手术的适应症包括帕金森病 (82)、肌张力障碍 (18)、不同病因的震颤 (21)、亨廷顿病 (1) 和抽动秽语综合征 (1)。 AE 被定义为与外科手术、植入装置或正在进行的 DBS 治疗相关或无关的任何不良临床事件、体征或患者主诉或意外疾病。在 4.7 年（578 名患者年）的平均/中位随访期内，123 名患者中有 106 名 (86.2%) 记录了 433 例 AE。手术过程中没有出现死亡或持续发病的情况。手术后 4 周内发生的所有严重不良事件 (SAE) 都是可逆的。最常记录的是神经系统 AE（85 名患者中 193 例）和精神科 AE（48 名患者中 78 例）。 4 名患者的 AE（GPI 刺激下自杀、体重增加 >20 kg、步态和语言障碍、术后 2 年以上认知能力下降）为严重或更严重，至少可能与 DBS 相关且不可逆。在 PD 中，23.1% 的 STN 刺激患者经历了不可逆（或未知可逆性）AE，这些 AE 至少可能与 DBS 相关，表现为言语或步态受损、抑郁、体重增加、认知障碍或尿失禁（18 名患者中有 15 名严重程度为轻度或中度）。 STN 模拟的 PD 患者的年龄和 Hoehn&Yahr 分期与 AE 数量呈弱相关（分别为 r = 0.24 和 0.22），但与术前运动障碍或对左旋多巴的反应无关。严重或更严重且不可逆的 DBS 相关 AE 仅在 PD 中观察到（82 名患者中的 4 名；4.9%），但在其他疾病中未观察到。 PD 患者表现出非严重 AE 的显着风险，其中大多数也代表 PD 先前存在的和进行性的轴性和非运动症状。在 VIM 刺激下，轻度步态和/或言语障碍是相当常见的主诉。 GPI 刺激可用于治疗肌张力障碍，而与 DBS 相关的副作用可以忽略不计。
The extent to which deep brain stimulation (DBS) can improve quality of life may be perceived as a permanent trade-off between neurological improvements and complications of therapy, comorbidities, and disease progression. We retrospectively investigated 123 consecutive and non-preselected patients. Indications for DBS surgery were Parkinson's disease (82), dystonia (18), tremor of different etiology (21), Huntington's disease (1) and Gilles de la Tourette syndrome (1). AEs were defined as any untoward clinical occurrence, sign or patient complaint or unintended disease if related or unrelated to the surgical procedures, implanted devices or ongoing DBS therapy. Over a mean/median follow-up period of 4.7 years (578 patient-years) 433 AEs were recorded in 106 of 123 patients (86.2%). There was no mortality or persistent morbidity from the surgical procedure. All serious adverse events (SAEs) that occurred within 4 weeks of surgery were reversible. Neurological AEs (193 in 85 patients) and psychiatric AEs (78 in 48 patients) were documented most frequently. AEs in 4 patients (suicide under GPI stimulation, weight gain >20 kg, impairment of gait and speech, cognitive decline >2 years following surgery) were severe or worse, at least possibly related to DBS and non reversible. In PD 23.1% of the STN-stimulated patients experienced non-reversible (or unknown reversibility) AEs that were at least possibly related to DBS in the form of impaired speech or gait, depression, weight gain, cognitive disturbances or urinary incontinence (severity was mild or moderate in 15 of 18 patients). Age and Hoehn&Yahr stage of STN-simulated PD patients, but not preoperative motor impairment or response to levodopa, showed a weak correlation (r = 0.24 and 0.22, respectively) with the number of AEs. DBS-related AEs that were severe or worse and non-reversible were only observed in PD (4 of 82 patients; 4.9%), but not in other diseases. PD patients exhibited a significant risk for non-severe AEs most of which also represented preexisting and progressive axial and non-motor symptoms of PD. Mild gait and/or speech disturbances were rather frequent complaints under VIM stimulation. GPI stimulation for dystonia could be applied with negligible DBS-related side effects.