Retrospective review of factors leading to dissatisfaction with subthalamic nucleus deep brain stimulation during long-term management.
Retrospective review of factors leading to dissatisfaction with subthalamic nucleus deep brain stimulation during long-term management.
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DOI：
10.4103/2152-7806.112612
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发表时间：
2013
影响因子：
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通讯作者：
Giroux M
中科院分区：
文献类型：
--
作者：
Farris S;Giroux M
丘脑底核深部脑刺激在适当选择帕金森病患者的运动症状方面是有效的。我们确定了一系列患者在刺激管理的早期、中期和晚期导致不良结果的因素，这些患者被推荐用于诊断不良结果。我们对在我们的运动障碍门诊中发现的50例双侧STN DBS患者进行了回顾，这些患者的临床反应不满意和/或患者对深部脑刺激结果不满意。所有患者都接受了系统评估，以评估导致结果不佳的主要原因，包括导联位置、硬件完整性、患者选择、患者期望、刺激设置的有效使用以及左旋多巴治疗前后的反应症状。数据还按刺激持续时间进行分析，以确定这些因素是否随DBS管理阶段的不同而变化。我们的研究对象包括植入4-68个月的患者。我们确定了以下影响结果的主要因素：次优刺激设置(52%)、疾病进展(16%)、患者选择不当(10%)、硬件损坏(8%)、导线错位(8%)、满足预期运动结果(6%)。导联翻修手术发生率为14%。可逆因素占不满意的74%。在早期和长期管理阶段，次优刺激是影响结果的主要因素。即使在植入数年后，STN DBS的预后也可以改善。刺激参数作为不良结果的可逆原因，值得在整个星展银行管理的连续体中进行调查。
Subthalamic nucleus deep brain stimulation is effective in reducing motor symptoms in appropriately selected patients with Parkinson's disease. We identified factors that contribute to poor outcomes during early, middle and late stages of stimulation management in a series of patients that were referred for troubleshooting poor outcomes. We performed a retrospective review of 50 patients with bilateral STN DBS seen in our movement disorders clinic with unsatisfactory clinical response and/or patient dissatisfaction with deep brain stimulation outcome. All patients underwent a systematic evaluation to assess the primary cause of suboptimal outcome including lead position, hardware integrity, patient selection, patient expectations, effective use of stimulation settings, and pre- and postoperative levodopa responsive symptoms. The data was also analyzed by duration of stimulation to determine if these factors varied by stage of DBS management. Our series included patients implanted 4-68 months. We identified the following primary factors impacting outcome: Suboptimal stimulation settings (52%), disease progression (16%), inappropriate patient selection (10%), hardware damage (8%), lead malposition (8%), met expected motor outcomes (6%). Lead revision surgery occurred in 14%. Reversible factors accounted for dissatisfaction in 74%. Suboptimal stimulation was the dominant factor affecting outcomes in early and long-term management phases. STN DBS outcomes can be improved even years after implantation. Stimulation parameters warrant investigation throughout the continuum of DBS management as a reversible cause of poor outcomes.