Nonmotor Symptoms and Subthalamic Deep Brain Stimulation in Parkinson's Disease.
Nonmotor Symptoms and Subthalamic Deep Brain Stimulation in Parkinson's Disease.
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DOI：
10.14802/jmd.15010
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发表时间：
2015-05
影响因子：
3.9
通讯作者：
Paek SH
中科院分区：
文献类型：
--
作者：
Kim HJ;Jeon BS;Paek SH
下丘脑深部脑刺激（STN DBS）是一种治疗晚期帕金森病（PD）患者运动症状的有效方法。除了运动症状的改善外，许多研究报道了PD患者STN DBS后各种非运动症状（NMSs）的改变。精神症状，包括抑郁、冷漠、焦虑和冲动，可根据电刺激参数、刺激接触在STN内的位置以及手术后药物的变化而恶化或改善。整体认知功能不受STN DBS的影响，与药物治疗相比，STN DBS后痴呆的发生率没有增加，尽管一直有临床不显著的语言流畅性下降的报道。疼痛，尤其是与pd相关的疼痛，在STN DBS中得到改善。关于STN DBS对自主神经症状和睡眠相关问题的影响的证据有限，并且仍然相互矛盾。许多非运动性波动的症状，有时比运动性波动更麻烦，在STN DBS中得到改善。虽然NMSs显然不是STN DBS的目标症状，但NMSs对PD患者的生活质量有很大影响，因此临床医生在决定是否进行手术时应了解这些NMSs，并应注意STN DBS后这些症状的变化，以确保对患者的最佳护理。
Subthalamic deep brain stimulation (STN DBS) is an established treatment for the motor symptoms in patients with advanced Parkinson’s disease (PD). In addition to improvements in motor symptoms, many studies have reported changes in various nonmotor symptoms (NMSs) after STN DBS in patients with PD. Psychiatric symptoms, including depression, apathy, anxiety, and impulsivity, can worsen or improve depending on the electrical stimulation parameters, the locations of the stimulating contacts within the STN, and changes in medications after surgery. Global cognitive function is not affected by STN DBS, and there is no increase in the incidence of dementia after STN DBS compared to that after medical treatment, although clinically insignificant declines in verbal fluency have been consistently reported. Pain, especially PD-related pain, improves with STN DBS. Evidence regarding the effects of STN DBS on autonomic symptoms and sleep-related problems is limited and remains conflicting. Many symptoms of nonmotor fluctuations, which are occasionally more troublesome than motor fluctuations, improve with STN DBS. Although it is clear that NMSs are not target symptoms for STN DBS, NMSs have a strong influence on the quality of life of patients with PD, and clinicians should thus be aware of these NMSs when deciding whether to perform surgery and should pay attention to changes in these symptoms after STN DBS to ensure the optimal care for patients.