Bilateral subthalamic stimulation in patients with Parkinson disease: long-term follow up
Bilateral subthalamic stimulation in patients with Parkinson disease: long-term follow up
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DOI：
10.3171/jns.2003.99.1.0071
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发表时间：
2003-07-01
影响因子：
4.1
通讯作者：
Lyons, KE
中科院分区：
文献类型：
--
作者：
Pahwa, R;Wilkinson, SB;Lyons, KE
物体。双侧丘脑底核(STN)刺激在晚期帕金森病(PD)患者中的应用越来越多。本研究旨在评价双侧STN电刺激治疗PD的远期疗效和安全性。作者在接受双侧STN刺激的帕金森病患者中进行了一项前瞻性开放研究。作者根据统一的PD评定量表(UPDRS)，将患者术前处于停药状态时的运动评分和日常生活活动能力(ADL)评分与这些患者在停药/刺激器开启状态下的随访评分进行了比较。33名帕金森病患者在术后12个月接受评估，19名患者在平均28个月的随访时间内接受评估。将处于停药/刺激器开启状态的患者的UPDRS评分与处于基线停药状态的患者的UPDRS评分进行比较，结果显示术后ADL评分提高了27%，运动评分提高了28%。左旋多巴等量药物剂量的使用减少了57%。患者清醒时处于服药状态的比例从38%增加到72%。手术并发症包括癫痫(3例)、神志不清(5例)、偏瘫(1例)和视力障碍(1例)。与刺激相关的不良反应轻微。与设备相关的事件包括9次导线更换、7次导线修正、6次延长更换和12次植入式脉冲发生器(IPG)更换；1例IPG被清洗，1例IPG因存在分流而被放入口袋。双侧STN模拟与帕金森病患者运动特征的显著改善有关。与设备相关的事件在接受手术的前20名患者中很常见，通常需要重复手术。
Object. Bilateral subthalamic nucleus (STN) stimulation is increasingly used in patients with advanced Parkinson disease (PD). This study was performed to evaluate the long-term efficacy and safety of bilateral STN stimulation in cases of PD.Methods. The authors performed a prospective, open-label study in patients with PD who underwent bilateral STN stimulation. The authors compared motor scores and activities of daily living (ADL) scores based on the Unified PD Rating Scale (UPDRS) obtained before surgery while patients were in the medication-off state with scores obtained at follow-up evaluations of these patients while in the medication-off/stimulator-on state. Data contained in patient diaries were also compared.Thirty-three patients with PD were evaluated 12 months postoperatively and 19 were evaluated at a mean follow-up time of 28 months. A comparison between UPDRS scores obtained in patients in the medication-off/stimulator-on state and those obtained when patients were in the baseline medication-off state showed a 27% improvement in ADL scores and a 28% improvement in motor scores after surgery. There was a 57% reduction in the use of levodopa-equivalent medication doses. The percentage of the waking day that patients were in the medication-on state increased from 38 to 72%. Surgical complications included seizures (three patients), confusion (five patients), hemiballismus (one patient), and visual disturbance (one patient). Stimulation-related adverse effects were mild. Device-related events included nine lead replacements, seven lead revisions, six extension replacements, and 12 implantable pulse generator (IPG) replacements; one IPG was cleaned and one IPG was placed in a pocket because of the presence of a shunt.Conclusions. Bilateral STN simulation is associated with a significant improvement in the motor features of PD. Device-related events were common in the first 20 patients who underwent surgery, often requiring repeated surgeries.