The effect of unilateral subthalamic nucleus deep brain stimulation on depression in Parkinson's disease.
The effect of unilateral subthalamic nucleus deep brain stimulation on depression in Parkinson's disease.
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DOI：
10.1016/j.brs.2016.12.014
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发表时间：
2017-05
影响因子：
7.7
通讯作者：
Amara AW
中科院分区：
文献类型：
--
作者：
Birchall EL;Walker HC;Cutter G;Guthrie S;Joop A;Memon RA;Watts RL;Standaert DG;Amara AW
抑郁症在帕金森病（PD）中很常见，并对生活质量产生不利影响。单侧和双侧丘脑底（DBS）脑深部电刺激（DBS）均能有效治疗PD的运动症状，但关于单侧丘脑底DBS对非运动症状（如抑郁症）的影响仍存在问题。我们报告了50例接受单侧DBS的PD患者的抑郁变化，采用汉密尔顿抑郁评定量表（HAMD-17）进行测量。参与者还接受了帕金森病问卷第三部分，帕金森病问卷-39和匹兹堡睡眠质量指数的评估。主要结局是6个月时HAMD-17与术前基线相比的变化，采用重复测量方差分析（ANOVA）。次要结局包括术后3、12、18和24个月时HAMD-17的变化以及使用Pearson相关系数的结局变量之间的相关性。作为对照，我们还评估了25例未接受DBS的晚期PD患者的HAMD-17变化。与术前基线（7.90±4.44）（平均值±标准差）相比，单侧DBS患者术后6个月的抑郁症显著改善（4.94±4.02）（p=<0.0001）。HAMD-17评分在任何时间点均与WESTERS第三部分无关。有趣的是，HAMD-17与基线、术后3个月和6个月的睡眠质量和生活质量显著相关。没有DBS的参与者在相同的时间间隔内HAMD-17没有显著变化。单侧DBS可改善PD患者术后6个月的抑郁。抑郁症的改善会随着时间的推移而保持，并与睡眠质量和生活质量的改善相关。
Depression is common in Parkinson’s disease (PD) and adversely affects quality of life. Both unilateral and bilateral subthalamic (STN) deep brain stimulation (DBS) effectively treat the motor symptoms of PD, but questions remain regarding the impact of unilateral STN DBS on non-motor symptoms, such as depression. We report changes in depression, as measured by the Hamilton Depression Rating Scale (HAMD-17), in 50 consecutive PD patients who underwent unilateral STN DBS. Participants were also evaluated with UPDRS part III, Parkinson’s Disease Questionnaire-39, and Pittsburgh Sleep Quality Index. The primary outcome was change in HAMD-17 at 6 months versus pre-operative baseline, using repeated measures analysis of variance (ANOVA). Secondary outcomes included the change in HAMD-17 at 3, 12, 18, and 24 months post-operatively and correlations amongst outcome variables using Pearson correlation coefficients. As a control, we also evaluated changes in HAMD-17 in 25 advanced PD patients who did not undergo DBS. Participants with unilateral STN DBS experienced significant improvement in depression 6 months post-operatively (4.94±4.02) compared to preoperative baseline (7.90±4.44) (mean±SD) (p=<0.0001). HAMD-17 scores did not correlate with UPDRS part III at any time-point. Interestingly, the HAMD-17 was significantly correlated with sleep quality and quality of life at baseline, 3 months, and 6 months post-operatively. Participants without DBS experienced no significant change in HAMD-17 over the same interval. Unilateral STN DBS improves depression 6 months post-operatively in patients with PD. Improvement in depression is maintained over time and correlates with improvement in sleep quality and quality of life.