Behavioural disorders, Parkinson's disease and subthalamic stimulation
Behavioural disorders, Parkinson's disease and subthalamic stimulation
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DOI：
10.1136/jnnp.72.6.701
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发表时间：
2002-06-01
影响因子：
11
通讯作者：
Agid, Y
中科院分区：
文献类型：
--
作者：
Houeto, JL;Mesnage, V;Agid, Y
目的：分析24例帕金森病患者经双侧脑干电刺激治疗成功后的行为障碍，方法：回顾性分析患者的适应障碍（社会适应量表，SAS），精神疾病（精神科访谈与迷你国际神经精神量表结果的比较）与人格改变结果：帕金森病患者运动功能障碍改善69.5%，左旋多巴等效日剂量减少60.5%。9例患者的社会适应（SAS）被认为是良好或极好，15例患者中度（n= 14）或重度（n= 1）受损。精神疾病包括先前存在的疾病的放大或失代偿，这些疾病有时会被忽视，例如抑郁发作（n=4）、广泛性焦虑（n=18）和药物依赖性行为障碍（n=2）。15例患者报告出现轻度至中度情绪高反应。结论：脑电刺激诱发的帕金森病运动功能障碍的改善并不一定伴随着精神功能和生活质量的改善，应注意帕金森病患者可能出现的人格障碍和既往精神障碍的失代偿，这些患者适合接受神经外科手术。我们建议在手术前进行仔细的心理和精神访谈，并强调需要进行心理随访，以确保最佳的结果。
Objective: to analyse 24 parkinsonian patients successfully treated by bilateral STN stimulation for the presence of behavioural disorders.Method: patients were evaluated retrospectively for adjustment disorders (social adjustment scale, SAS), psychiatric disorders (comparison of the results of psychiatric interview and the mini international neuropsychiatric inventory) and personality changes (IOWA scale of personality changes).Results: parkinsonian motor disability was improved by 69.5% and the levodopa equivalent daily dosage was reduced by 60.5%. Social adjustment (SAS) was considered good or excellent in nine patients, moderately (n= 14), or severely (n= 1) impaired in 15 patients. Psychiatric disorders consisted of amplification or decompensation of previously existing disorders that had sometimes passed unnoticed, such as depressive episodes (n=4), generalised anxiety (n=18), and behavioural disorders with drug dependence (n=2). Appearance of mild to moderate emotional hyperreactivity was reported in 15 patients. Personality traits (IOWA scale) were improved in eight patients, unchanged in seven, and aggravated in eightConclusion: Improvement in parkinsonian motor disability induced by STN stimulation is not necessarily accompanied by improvement in psychic function and quality of life, Attention is drawn to the possible appearance of personality disorders and decompensation of previous psychiatric disorders in parkinsonian patients who are suitable candidates for neurosurgery. We suggest that a careful psychological and psychiatric interview be performed before surgery, and emphasise the need for psychological follow up to ensure the best possible outcome.