Comparison of Subthalamic Nucleus Deep Brain Stimulation and Duodopa in the Treatment of Advanced Parkinson's Disease
Comparison of Subthalamic Nucleus Deep Brain Stimulation and Duodopa in the Treatment of Advanced Parkinson's Disease
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DOI：
10.1002/mds.23524
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发表时间：
2011-03-01
影响因子：
8.6
通讯作者：
Lopiano, Leonardo
中科院分区：
文献类型：
--
作者：
Merola, Aristide;Zibetti, Maurizio;Lopiano, Leonardo
背景资料：丘脑底核脑深部电刺激（STN-DBS）和左旋多巴/卡比多巴肠内（Duodopa）输注是治疗晚期帕金森病（PD）的两种有效的治疗选择。方法：回顾性，本研究比较了这两种方法，评估了40例接受STN-DBS或经皮胃造口术（PEG）的PD患者。Duodopa组包括20名患者，平均随访时间约为15个月，由于存在神经外科禁忌症、年龄> 70岁、中度认知障碍或患者不愿意接受神经外科手术，因此接受Duodopa输注而不是STN-DBS治疗。STN-DBS组由20名连续患者组成，这些患者在疾病发作时的年龄、手术时的年龄、随访和运动并发症的持续时间方面与Duodopa组的患者相似。唯一的差异涉及神经心理功能，Duodopa组患者的神经心理功能受损更严重。临床和神经心理学数据进行了比较，在基线和后续的两个procedure.Results：两个程序显示出显着改善，在TRORS-II，TRORS-III，和TRORS-IV和清醒的一天花在“关闭”的百分比相当大的减少，而只有STN-DBS组表现出运动障碍的持续时间和残疾的显着改善。STN-DBS与音素语言流畅性评分的显著下降相关，而Duodopa患者在这项任务中表现出较轻的恶化。结论：STN-DBS和Duodopa对运动症状、日常生活能力和运动并发症均有显著疗效。多多巴治疗组患者发生更多手术相关并发症。(C)2011年运动障碍协会
Background: Subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa/carbidopa enteral (Duodopa) infusion are two effective therapeutic options for the treatment of advanced Parkinson's disease (PD).Methods: Retrospectively, this study compared the two procedures, evaluating 40 PD patients who underwent either STN-DBS or a percutaneous gastrostomy (PEG) for Duodopa infusion. Duodopa group comprised 20 patients, with a mean follow-up of similar to 15 months, treated by Duodopa infusion rather than STN-DBS because of the presence of neurosurgical contraindications, age > 70 years-old, moderate cognitive impairment or patient's unwillingness to undergo neurosurgery. The STN-DBS group comprised 20 consecutive patients similar to the patients of the Duodopa group for age at the disease onset, age at the procedure, follow-up, and duration of motor complications. The only difference concerned neuropsychological functions, which were more impaired in the group of Duodopa patients. Clinical and neuropsychological data were compared at baseline and at follow-up for the two procedures.Results: Both procedures showed a significant improvement in UPDRS-II, UPDRS-III, and UPDRS-IV and a considerable reduction in the percentage of waking day spent in "off,'' whereas only the STN-DBS group showed a significant improvement in dyskinesias duration and disability. STN-DBS was associated to a significant drop in the phonemic verbal fluency score, whereas Duodopa patients showed a milder worsening in this task. The procedure-related complications occurred more frequently with Duodopa.Conclusion: STN-DBS and Duodopa showed a significant efficacy on motor symptoms, activities of daily living, and motor complications. The group of Duodopa-treated patients developed more procedure-related complications. (C) 2011 Movement Disorder Society