Influence of chronic bilateral stimulation of the subthalamic nucleus on cognitive function in Parkinson's disease
Influence of chronic bilateral stimulation of the subthalamic nucleus on cognitive function in Parkinson's disease
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DOI：
10.1007/s004150170139
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发表时间：
2001-07-01
影响因子：
6
通讯作者：
Destée, A
中科院分区：
文献类型：
--
作者：
Dujardin, K;Defebvre, L;Destée, A
背景资料：慢性脑深部电刺激治疗伴有严重左旋多巴相关运动不良反应的帕金森病患者的临床疗效已被反复证实。双侧丘脑底核（subthalamic nucleus，简称丘脑底核）刺激比苍白球刺激更有优势，因为它诱导更高的抗运动不能作用，对所有帕金森病症状都有积极作用。这种手术的发病率通常被认为是非常低的。然而，很少有研究广泛地研究慢性脑电刺激对认知功能的影响。目的：本研究的目的是评估慢性双侧脑干刺激对手术后三个月和一年的广泛神经心理学测试的影响。方法：9例帕金森病患者接受双极电极植入术。他们在手术前一个月和手术后三个月进行了神经心理学评估。其中6例于术后1年复查。结果：术前无患者出现认知功能下降。在术后三个月，大多数任务没有观察到改变。信息处理速度趋于提高。在延迟自由回忆测试中表现出显着降低，并且有明显降低类别词流畅性的趋势。术后一年，大多数任务指标没有变化。执行功能评估任务出现轻微损伤。对个体结果的检查显示，一些患者（术后3个月时为30%）表现出整体认知能力下降。在4例患者中也观察到行为变化，其中1例患者整体认知能力下降。结论：一般来说，脑深部电刺激可以被认为是治疗严重帕金森病的重要贡献，但在某些患者中，它可能会导致整体认知能力下降或行为改变。
Background: The clinical efficacy of chronic deep brain stimulation in the treatment of parkinsonian patients with severe levodopa-related motor adverse effects has been repeatedly shown. Bilateral subthalamic nucleus (STN) stimulation has been shown to present an advantage over pallidal stimulation as it induces a higher antiakinetic effect and has positive effects on all parkinsonian symptoms. The morbidity of such surgery is usually considered to be very low. However, few studies have extensively examined the effects of chronic STN stimulation on cognitive function. Objective: The aim of the present study was to assess the effects of chronic bilateral STN stimulation on performance in an extensive battery of neuropsychological tests, three months and one year after surgery. Methods: Nine patients with Parkinson's disease were selected for STN electrodes implantation. They underwent a neuropsychological evaluation at one month before and at three months after surgery. Six of them were examined again at one year after surgery. Results: Before surgery, no patient showed cognitive decline. At three months after surgery, no modification was observed for most tasks. The information processing speed tended to improve. There was a significant reduction of the performance in a delayed free recall test and a trend toward a significant reduction of categorial word fluency. At one year after surgery, most task measures did not change. Slight impairment was observed for tasks evaluating executive function. Examination of individual results showed that some patients (30% at 3 months after surgery) showed an overall cognitive decline. Behavioural changes were also observed in 4 patients with overall cognitive decline in one of them. Conclusion: In general, STN deep brain stimulation can be considered as a significant contribution to the treatment of severe Parkinson's disease However, in some patients it can induce overall cognitive decline or behavioural changes.