Long-term efficacy of subthalamic nuclei electrical stimulation in different subtypes of Parkinson disease

doi:10.3969/j.issn.1009-6574.2015.05.004

Abstract：Objective To assess the long -term efficacy of deep brain stimulation (DBS) in bilater‐al subthalamic nucleus(STN) with different subtypes of Parkinson disease(PD) .Methods A total of 49 cases of idiopathic PD patients treated with bilateral STN -DBS ,including 27 males and 22 females were analyzed .The average age was (56 .8 ± 9 .4) years old and the mean disease duration was (8 .2 ± 4 .1) years .Unified Parkinson's Disease Rating Scale (UPDRS) was assessed in on and off period before and after STN -DBS .Based on the UPDRS Ⅲ tremor and non -tremor scores in preoperative off period , patients were divided into tremor -dominant type (TDT ) ,rigidity slow type (ART ) ,and mixed type (MT) preoperatively .Paired t test was carried out to compare the UPDRS scores with preoperative and postoperative patients in three subtypes .Results After (4 .8 ± 1 .4) average years of follow up ,for all patients in off period ,UPDRS Ⅲ sports improvement rate was 50 .8% ,UPDRS Ⅱ daily life ability im‐provement rate was 32 .9% .Postoperative daily living of rigidity slow patients significantly increased (P < 0 .05);UPDRS Ⅲ score and each item score including tremor ,rigidity ,slow ,postural stability and gait disturbance were significantly improved after surgery in rigidity slow and mixed patients (P <0.05) .In particular ,tremor symptoms were obviously improved in tremor patients (P< 0 .05) .The du‐ration of dyskinesia reduced significantly and degree of disability decreased in rigidity slow patients after surgery ,the difference was statistically significant (P < 0 .05) .The daily intake dose of dopamine was reduced than preoperative in three types of patients .However ,long -term efficacy analysis showed that swallowing disorders ,language barriers were getting worsen in part of rigidity slow and mixed patients (P < 0 .05) .Stimulation pulse width ,frequency and voltage in three groups had no obvious difference . Conclusions Bilateral STN -DBS can effectively improve the motor symptoms and dyskinesia with dif‐ferent types of PD patients over a long period ,and reduce the daily doses of dopamine drugs .But for some rigidity slow and mixed patients with rapid progression ,STN -DBS cannot effectively improve the symptoms of dysphagia and language barrier .