双侧GPI的长期临床结果在高级帕金森病中的双侧脑刺激:5年及以后

祝贺博士。 Takashi Tsuboi Janine Lemos Melo Lobo J的ili Lopes,Kathryn Moore,Bhavana Patel,Joseph Legacy,Adrianna M。 Ratajska,Dawn Bowers,Robert S. Euteer,Leonardo Almeida ,凯莉d。迈克,迈克尔。 okun, Adolfo Ramirez-Zamora在出版物上“晚期帕金森病中的双侧GPI深脑刺激的长期临床结果:5年及以后。”本文发表于10月份神经科学期刊。

抽象

目的

少数研究报告了帕金森病(PD)的Globus pallidus Internus(GPI)深脑刺激(DBS)的长期结果。作者旨在调查双侧GPI DBS的长期结果5年及以后的PD患者。

方法

作者回顾性地分析了在单一中心的双侧GPI DBS治疗的65个PD患者中的临床结果。运动症状和与健康相关生活质量(HRQOL)的结果措施包括统一帕金森病评级规模(UPDRS)和帕金森病问卷(PDQ-39)。将基线的评分与在植入后1,3,5和6-8岁的比较,使用Wilcoxon签名级别测试与α校正。

结果

GPi DBS significantly improved the off-medication UPDRS III total scores, UPDRS IV, and dyskinesia score at 1 year when compared with baseline (all p < 0.001). The off- and on-medication tremor scores, UPDRS IV, and dyskinesia scores showed moderate and sustained improvement (the ranges of the mean percentage improvement at each time point were 61%–75%, 30%–80%, 29%–40%, and 40%–65%, respectively) despite lacking statistical significance at long-term follow-up with diminishing sample sizes. The off-medication UPDRS III total scores did not show significant improvement at 5 years or later, primarily because of worsening in rigidity, akinesia, speech, gait, and postural stability scores. The on-medication UPDRS III total scores also worsened over time, with a significant worsening at 6–8 years when compared with baseline (p = 0.008). The HRQoL analyses based on the PDQ-39 revealed significant improvement in the activities 的 daily living and discomfort domains at 1 year (p = 0.003 and 0.006, respectively); however, all the domains showed gradual worsening at the later time points without reaching statistical significance. At 3 years, the communication domain showed significant worsening compared with baseline scores (p = 0.002).

结论

在这种单中心队列中的PD患者中GPI DBS与诸如药物震颤和震颤的震颤和电机并发症中的持续长期效益相关。 HRQOL和震颤以外的红衣主教症状可能长期逐步恶化。在咨询患者时,重要的是要认识到,在双侧GPI DBS植入后,预计震颤和动脉瘤的益处将是最持久的。