丘脑底核脑深部电刺激术治疗伴有异动的帕金森病的疗效分析

Efficacy of subthalamic deep brain stimulation for levodopa-induced dyskinesia in patients with Parkinson’s disease:retrospective analysis of 12 cases

目的评估丘脑底核(subthalamic nucleus,STN)脑深部电刺激术(deep brain stimulation,DBS)对伴有异动的帕金森病的治疗效果,并探讨STN-DBS治疗异动症状(levodopa-induced dyskinesia,LID)的可行性及其可能机制。方法对2016年3月至2019年12月于本中心行STN-DBS治疗的帕金森病患者进行回顾性分析。术前及术后6个月随访均使用统一帕金森病评定量表(UPDRS)Ⅲ部分、Ⅳ部分和异动评分(UPDRSⅣ部分第32~34项)以及左旋多巴等效剂量(levodopa equivalent daily dose,LEDD)评估疗效。结果STN-DBS术后6个月,最终所纳入的12例患者异动症状均明显改善,UPDRSⅣ评分和异动评分术后改善率分别为(45.91±13.01)%和(61.96±22.03)%。术后6个月,有2例患者左旋多巴等效剂量维持术前剂量,其余10例患者均减少了药物剂量,最高者减药率达72.00%,平均43.58%。同时,所有患者运动症状也得到显著改善,UPDRSⅢ评分关期改善率为(68.14±9.51)%。结论STN-DBS能明显改善帕金森患者的异动症状,其不仅能通过减药控制异动症,还能对异动症有直接抑制作用。

Objective To evaluate the clinical effectiveness of bilateral subthalamic nucleus(STN)deep brain stimulation(DBS)in treatment of levodopa-induced dyskinesia(LID)in patients with Parkinson’s disease(PD),and to explore the feasibility and the possible underlying mechanism of the treatment.Methods A retrospective review was conducted on all the PD patients who underwent STN-DBS in our department from March 2016 to December 2019.Unified Parkinson’s Disease Rating Scale(UPDRS)partⅢand partⅣ,dyskinesia subscore(items 32 to 34 of UPDRS partⅣ)and the levodopa equivalent daily dose(LEDD),which were used to evaluate the improvement of the symptoms before and in 6 months after operation.Results In 6 months after STN-DBS,the LID symptoms of the 12 patients finally enrolled were significantly improved,with the improvement rates of UPDRSⅣscore and dyskinesia subscore of(45.91±13.01)%and(61.96±22.03)%,respectively.Among them,the LEDD was maintained in 2 patients,and reduced in the other 10 patients,with the averagely reduced rate of 43.58%,and the highest rate of 72.00%.Meanwhile,the motor symptoms of all patients were also significantly improved,and the improvement rate of UPDRSⅢscore was(68.14±9.51)%.Conclusion STN-DBS significantly improves dyskinesia symptom of PD patients.Its anti-dyskinesia effect may be not only related to reduction of drug dose,but also to direct inhibition of LID.