Neurosurgery in Parkinson disease
Neurosurgery in Parkinson disease
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帕金森病的神经外科
作者：
M. Schupbach;M. Gargiulo;M. Welter;L. Mallet;C. Béhar;J. Houeto;D. Maltête;Valérie Mesnage;Y. Agid
目的：前瞻性评估丘脑底核（STN）刺激对帕金森病（PD）患者社会适应的影响。方法：在双侧 STN 刺激之前和之后 18 至 24 个月，作者使用非结构化深度访谈评估了 29 名 PD 患者的运动障碍、认知（Mattis 痴呆评定量表、额叶评分）、精神发病率（Mini-5.0.0、MADRS、BAS）、生活质量（PDQ-39）、社会适应（社会适应量表）和心理状态。结果：尽管到研究结束时，帕金森运动障碍有显着改善，认知状态没有显着变化，日常生活活动和生活质量也有所改善，但社会适应并没有改善。观察到多种社会适应问题，影响患者对自己和身体的看法、婚姻状况和职业生活。 17/24 的夫妇发生了婚姻冲突。手术前有过职业活动的 16 名患者中，只有 9 人在手术后重返工作岗位。结论：接受 STN 刺激后，患者在与自己、配偶、家庭以及社会职业环境的关系中遇到困难。作者建议进行多学科的心理社会准备和随访，以帮助患者及其随行人员应对成功的神经外科手术后生活中的突然变化。
Objective: To prospectively evaluate the impact of subthalamic nucleus (STN) stimulation on social adjustment in patients with Parkinson disease (PD). Methods: Before and 18 to 24 months after bilateral STN stimulation, the authors assessed 29 patients with PD for motor disability, cognition (Mattis dementia rating scale, frontal score), psychiatric morbidity (Mini-5.0.0, MADRS, BAS), quality of life (PDQ-39), social adjustment (Social Adjustment Scale), and psychological status using unstructured in-depth interviews. Results: Despite marked improvement in parkinsonian motor disability, the absence of significant changes in cognitive status, and improvement of activities of daily living and quality of life by the end of the study, social adjustment did not improve. Several kinds of problems with social adjustment were observed, affecting the patients’ perception of themselves and their body, marital situation, and professional life. Marital conflicts occurred in 17/24 couples. Only 9 out of 16 patients who had a professional activity before the operation went back to work after surgery. Conclusion: After STN stimulation, patients experienced difficulties in their relations with themselves, their spouses, their families, and their socio-professional environment. The authors suggest a multidisciplinary psychosocial preparation and follow-up to help patients and their entourage cope with the sudden changes in their existence following successful neurosurgery.