Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson's disease predictable?
Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson's disease predictable?
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DOI：
10.1002/mds.23907
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发表时间：
2011-12-01
影响因子：
8.6
通讯作者：
Witt, Karsten
中科院分区：
文献类型：
--
作者：
Daniels, Christine;Krack, Paul;Witt, Karsten
丘脑底核（DBS）的脑深部电刺激（DBS）可显著改善PD患者的生活质量（QoL）。然而，相关比例的患者的生活质量未能改善。我们研究了与DBS后生活质量改善相关的临床基线和进展参数。分析了一项德国随机对照研究的数据，该研究比较了DBS（60例患者）与最佳药物治疗（59例患者）。在基线和6个月随访时，使用帕金森病问卷（PDQ-39）评估患者生活质量的变化。对于STN-DBS患者，PDQ-39的变化与预定义的临床术前和进展参数相关。57%的患者在STN-DBS后生活质量评分改善，43%的患者没有改善。生活质量改善的患者显示出显著更高的累积每日休息时间。PDQ-39的变化与基线时的累积每日休息时间呈显著正相关。Logistic回归分析显示，基线时额外1小时的休息时间使PDQ-39改善的几率增加了1.33倍（比值比）。在术后过程中，PDQ-39的变化与每日累积休息时间的减少、BPRS改善（BPRS III关闭）和积极的情绪变化显著相关。在基线参数中，累积每日休息时间是DBS后疾病相关QoL改善的最强预测因子。STN-DBS后生活质量的改善也与运动功能的变化以及抑郁和焦虑的变化相关。(c)2011年运动障碍学会
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in PD. However, QoL fails to improve in a relevant proportion of patients. We studied clinical baseline and progression parameters associated with improvement in QoL after DBS. Data from a German randomized, controlled study comparing DBS (60 patients) with best medical treatment (59 patients) were analyzed. Changes in patients' QoL were assessed using the Parkinson's Disease Questionnaire (PDQ-39) at baseline and at the 6-month follow-up. For the STN-DBS patients, the changes in PDQ-39 were correlated with predefined clinical preoperative and progression parameters. Scores for QoL improved after STN-DBS for 57% of the patients, and for 43% patients, they did not improve. Patients with improvement in QoL showed significantly higher cumulative daily off time. Changes in the PDQ-39 showed a significant positive correlation with the cumulative daily off time at baseline. Logistic regression analysis revealed that 1 additional hour off time at baseline increases the odds for improvement on PDQ-39 by a factor of 1.33 (odds ratio). In the postoperative course, changes in the PDQ-39 significantly correlated with the reduction of cumulative daily off time, an improvement on the UPDRS (UPDRS III off), and positive mood changes. Among the baseline parameters, the cumulative daily off time is the strongest predictor for improvement in disease-related QoL after DBS. Improvement in QoL after STN-DBS is also correlated with changes in motor functions and changes in depression and anxiety. (c) 2011 Movement Disorder Society