Subthalamic nucleus stimulation - Improvements in outcome with reprogramming
Subthalamic nucleus stimulation - Improvements in outcome with reprogramming
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DOI：
10.1001/archneur.63.9.noc60069
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发表时间：
2006-09-01
影响因子：
--
通讯作者：
Lang, Anthony E.
中科院分区：
文献类型：
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作者：
Moro, Elena;Poon, Yu-Yan W.;Lang, Anthony E.
背景：脑深部刺激(DBS)是目前治疗晚期帕金森病(PD)最有效的外科治疗方法。目的：通过一位运动障碍和DBS编程方面的神经科专家的亲身参与，确定是否可以通过修改刺激参数和药物剂量来改善丘脑底核DBS治疗帕金森病的稳定结果。方法：连续44例对DBS丘脑底核长期稳定反应的PD患者(平均+/-SD，3.5+/-1.7年)，我们比较了统一帕金森氏病评定量表第二部分到第四部分在刺激正式重新编程之前和之后获得的分数。重新编程由PD和DBS的神经科专家执行，并伴随着进一步的药物调整。结果：24例患者(54.6%)在统一帕金森病评定量表第II部分和第III部分的评分明显改善，分别提高了15.0%和25.9%。抗PD药物显著减少(25.9%)。16例(36.4%)患者病情无改善，4例(9.1%)病情恶化。结论：大部分患者在长期稳定刺激后仍能进一步改善帕金森症状。如果术后护理由运动障碍和DBS神经科专家亲自管理，DBS直接负责刺激编程和根据观察到的对不断变化的刺激参数的临床反应进行药物调整，则丘脑底核DBS的患者预后会得到改善。
Background: Deep brain stimulation (DBS) is currently the most effective surgical treatment for advanced Parkinson disease (PD). Even when the electrode is well positioned in the target, the optimization of clinical results depends on careful programming of electrical parameters and changes in antiparkinsonian drug dosages.Objective: To determine whether stable outcomes from subthalamic nucleus DBS for PD can be improved by revising stimulation parameters and drug dosages through "hands-on" involvement of a neurologist expert in both movement disorders and DBS programming.Methods: In 44 consecutive patients with PD with long-term stable response to subthalamic nucleus DBS ( mean +/- SD, 3.5 +/- 1.7 years), we compared scores from the Unified Parkinson's Disease Rating Scale parts II through IV obtained immediately before and following a formal reprogramming of their stimulation. The reprogramming was performed by a neurologist expert in both PD and DBS and accompanied by further medication adjustments. The patients were subsequently followed up for as long as 14 months.Results: In 24 patients (54.6%), the scores on the Unified Parkinson's Disease Rating Scale parts II and III significantly improved by 15.0% and 25.9%, respectively. Anti-PD drugs were significantly reduced ( by 25.9%). No improvement was observed in 16 patients (36.4%), and the conditions of 4 patients (9.1%) worsened.Conclusions: Further improvement of parkinsonian signs can be achieved in the majority of patients even after long-term stable stimulation. Improved patient outcomes from subthalamic nucleus DBS are obtained when postoperative care is personally managed by a neurologist expert in movement disorders and DBS who is directly responsible for stimulation programming and simultaneous drug adjustments based on observed clinical responses to changing stimulation parameters.