Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study
Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study
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DOI：
10.1007/s00415-023-11780-5
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发表时间：
2023-05-20
影响因子：
6
通讯作者：
Valzania, Franco
中科院分区：
文献类型：
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作者：
Cavallieri, Francesco;Campanini, Isabella;Valzania, Franco
目的评估双侧丘脑底核脑深部刺激（STN-DBS）对一组晚期帕金森病（PD）患者步态的长期影响。方法这项观察性研究包括接受双侧STN-DBS治疗的连续PD患者。评估了不同的刺激和药物治疗条件：刺激/停药、停刺激/停药和刺激/用药。每例患者均进行了仪器化计时启动测试（iTUG）。步行能力的仪器评估是用包含三维（3D）加速度计、陀螺仪和磁力计的可穿戴惯性传感器进行的。该装置可以提供三维线加速度、角速度和磁场矢量。疾病运动的严重程度进行了评估，总评分和分项分数的统一帕金森病评定量表第三部分。结果25例PD患者术后5年的中位随访（范围3-7）包括（18名男性，平均疾病持续时间在手术10.44 +/- 4.62年，平均年龄在手术58.40 +/- 5.73年）。刺激和药物治疗均缩短了iTUG的总持续时间及其大部分不同阶段，表明对术后步态具有长期有益影响。然而，比较两种治疗，多巴胺能治疗在所有测试阶段都有更显著的效果。STN-DBS单独减少总iTUG持续时间，坐到站，和第二个转弯阶段的持续时间，而它有一个较低的影响站到坐，第一个转弯，向前走，和走向后阶段的持续时间.ConclusionsThis研究强调，在手术后的长期，STN-DBS可能有助于步态和姿势控制的改善，当与多巴胺替代疗法一起使用时，仍然显示出实质性的有益效果。
ObjectiveTo assess the long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on gait in a cohort of advanced Parkinson's Disease (PD) patients.MethodsThis observational study included consecutive PD patients treated with bilateral STN-DBS. Different stimulation and drug treatment conditions were assessed: on-stimulation/off-medication, off-stimulation/off-medication, and on-stimulation/on-medication. Each patient performed the instrumented Timed Up and Go test (iTUG). The instrumental evaluation of walking ability was carried out with a wearable inertial sensor containing a three-dimensional (3D) accelerometer, gyroscope, and magnetometer. This device could provide 3D linear acceleration, angular velocity, and magnetic field vector. Disease motor severity was evaluated with the total score and subscores of the Unified Parkinson Disease Rating Scale part III.ResultsTwenty-five PD patients with a 5-years median follow-up after surgery (range 3-7) were included (18 men; mean disease duration at surgery 10.44 +/- 4.62 years; mean age at surgery 58.40 +/- 5.73 years). Both stimulation and medication reduced the total duration of the iTUG and most of its different phases, suggesting a long-term beneficial effect on gait after surgery. However, comparing the two treatments, dopaminergic therapy had a more marked effect in all test phases. STN-DBS alone reduced total iTUG duration, sit-to-stand, and second turn phases duration, while it had a lower effect on stand-to-sit, first turn, forward walking, and walking backward phases duration.ConclusionsThis study highlighted that in the long-term after surgery, STN-DBS may contribute to gait and postural control improvement when used together with dopamine replacement therapy, which still shows a substantial beneficial effect.