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파킨슨병 환자에서 양측 시상밑부 뇌심부자극의 효과: 신촌 세브란스 병원의 6개월 추적 관찰 결과

The Effect of Bilateral Subthalamic Nucleus Stimulation in Parkinson’s Disease: Experiences From 6 Month Follow-up in Sinchon Severance Hospital

장진우|손영호|신혜원
대한신경과학회 (Korean Neurological Association)|2008.05|대한신경과학회지 (Journal of the Korean Neurological Association)|제26권 제2호|pp. 110-117

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키워드

Deep brain stimulationParkinson diseaseSubthalamic nucleusShort-term effects
주제분류신경과학

초록

Background: Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as an effective neurosurgical procedure for the treatment of advanced Parkinson disease (PD). Although short- and long-term effects of STN stimulation in PD are relatively well known, an interim analysis of its efficacy is essential for us to continue with this procedure in the future. We present the clinical outcome of 6 month follow-up in patients who were assessed in our hospital after bilateral STN stimulation. Methods: Twenty-nine patients with PD treated with bilateral STN DBS were included in this study. The effect of STN DBS was assessed at 6 months after surgery, which included the followings; motor disability in ‘DBS- off/on, medication-off/on’ states, activity of daily living (ADL) in ‘medication-off/on’ states, levodopa-induced motor complication, daily levodopa and levodopa-equivalent dosage, neuropsychological assessment and quality of life. Results: Nineteen patients completed the follow-up assessment. STN stimulation produced significant improvements in the motor disability score both during ‘medication-off’ and ‘medication-on’ states. The ADL score was improved only in ‘medication-off’ states. The amount of levodopa-induced dyskinesia and response fluctuation also significantly decreased. Scores of Korean version of Mini-mental status examination (K-MMSE), Korean version of Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) and Beck Depression Inventory (BDI) did not change. Daily levodopa and levodopa-equivalent dosages were significantly reduced. No serious side effect was encountered. Conclusions: Bilateral STN DBS is a relatively safe and beneficial treatment for PD patients with levodopa- induced motor complications. In order to obtain a better prognosis in the future, we should assess the long-term outcome and the clinical predictive factors of STN DBS.

Abstract

Background: Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as an effective neurosurgical procedure for the treatment of advanced Parkinson disease (PD). Although short- and long-term effects of STN stimulation in PD are relatively well known, an interim analysis of its efficacy is essential for us to continue with this procedure in the future. We present the clinical outcome of 6 month follow-up in patients who were assessed in our hospital after bilateral STN stimulation. Methods: Twenty-nine patients with PD treated with bilateral STN DBS were included in this study. The effect of STN DBS was assessed at 6 months after surgery, which included the followings; motor disability in ‘DBS- off/on, medication-off/on’ states, activity of daily living (ADL) in ‘medication-off/on’ states, levodopa-induced motor complication, daily levodopa and levodopa-equivalent dosage, neuropsychological assessment and quality of life. Results: Nineteen patients completed the follow-up assessment. STN stimulation produced significant improvements in the motor disability score both during ‘medication-off’ and ‘medication-on’ states. The ADL score was improved only in ‘medication-off’ states. The amount of levodopa-induced dyskinesia and response fluctuation also significantly decreased. Scores of Korean version of Mini-mental status examination (K-MMSE), Korean version of Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) and Beck Depression Inventory (BDI) did not change. Daily levodopa and levodopa-equivalent dosages were significantly reduced. No serious side effect was encountered. Conclusions: Bilateral STN DBS is a relatively safe and beneficial treatment for PD patients with levodopa- induced motor complications. In order to obtain a better prognosis in the future, we should assess the long-term outcome and the clinical predictive factors of STN DBS.

참고문헌 (39)

  1. Deep-Brain Stimulation for Parkinson’s Disease Study Group, "Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease", N Engl J Med, 345, pp.956~963 (2001)
  2. Capecci M, "Functional improvement after subthalamic stimulation in Parkinson’s disease: a non-equivalent controlled study with 12-24 month follow up", J Neurol Neurosurg Psychiatry, 76, pp.769~774 (2005)
  3. Capus L, "Chronic bilateral electrical stimulation of the subthalamic nucleus for the treatment of advanced Parkinson’s disease", Neurol Sci, 22, pp.57~58 (2001)
  4. Esselink RA, "Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in Parkinson’s disease: one year follow-up of a randomised observer-blind multi centre trial", Acta Neurochir (Wien), 148, pp.1247~1255 (2006)
  5. Ford B, "Subthalamic nucleus stimulation in advanced Parkinson’s disease: blinded assessments at one year follow up", J Neurol Neurosurg Psychiatry, 75, pp.1255~1259 (2004)
  6. Gan J, "Bilateral subthalamic nucleus stimulation in advanced Parkinson’s disease: three years follow-up", J Neurol, 254, pp.99~106 (2007)
  7. Krack P, "Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease", N Engl J Med, 349, pp.1925~1934 (2003)
  8. Kumar R, "Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease", Neurology, 51, pp.850~855 (1998)
  9. Limousin P, "Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease", N Engl J Med, 339, pp.1105~1111 (1998)
  10. Lopiano L, "Deep brain stimulation of the subthalamic nucleus: clinical effectiveness and safety", Neurology, 56, pp.552~554 (2001)
  11. Moro E, "Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson’s disease", Neurology, 53, pp.85~90 (1999)
  12. Ostergaard K, "Effects of bilateral stimulation of the subthalamic nucleus in patients with severe Parkinson’s disease and motor fluctuations", Mov Disord, 17, pp.693~700 (2002)
  13. Rodriguez-Oroz MC, "Bilateral deep brain stimulation in Parkinson’s disease: a multicentre study with 4 years follow-up", Brain, 128, pp.2240~2249 (2005)
  14. Rodriguez-Oroz MC, "Efficacy of deep brain stimulation of the subthalamic nucleus in Parkinson’s disease 4 years after surgery: double blind and open label evaluation", J Neurol Neurosurg Psychiatry, 75, pp.1382~1385 (2004)
  15. Romito LM, "Long-term follow up of subthalamic nucleus stimulation in Parkinson’s disease", Neurology, 58, pp.1546~1550 (2002)
  16. Schupbach WM, "Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up", J Neurol Neurosurg Psychiatry, 76, pp.1640~1644 (2005)
  17. Thobois S, "Subthalamic nucleus stimulation in Parkinson’s disease: clinical evaluation of 18 patients", J Neurol, 249, pp.529~534 (2002)
  18. Visser-Vandewalle V, "Long-term effects of bilateral subthalamic nucleus stimulation in advanced Parkinson disease: a four year follow-up study", Parkinsonism Relat Disord, 11, pp.157~165 (2005)
  19. Volkmann J, "Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD", Neurology, 56, pp.548~551 (2001)
  20. Defer GL, "Core assessment program for surgical interventional therapies in Parkinson’s disease (CAPSIT-PD)", Mov Disord, 14, pp.572~584 (1999)
  21. Hagell P, "Clinical rating of dyskinesias in Parkinson’s disease: use and reliability of a new rating scale", Mov Disord, 14, pp.448~455 (1999)
  22. Beck AT, "An inventory for measuring depression", Arch Gen Psychiatry, 4, pp.561~571 (1961)
  23. Ware JE Jr, "The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection", Med Care, 30, pp.473~483 (1992)
  24. Houeto JL, "Subthalamic stimulation in Parkinson disease: a multidisciplinary approach", Arch Neurol, 57, pp.461~465 (2000)
  25. Esselink RA, "Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial", Neurology, 62, pp.201~207 (2004)
  26. Krack P, "Chronic stimulation of subthalamic nucleus improves levodopa-induced dyskinesias in Parkinson’s disease", Lancet, 350, pp.1676~ (1997)
  27. Fraix V, "Effect of subthalamic nucleus stimulation on levodopa-induced dyskinesia in Parkinson’s disease", Neurology, 55, pp.1921~1923 (2000)
  28. Drapier S, "Only physical aspects of quality of life are significantly improved by bilateral subthalamic stimulation in Parkinson’s disease", J Neurol, 252, pp.583~588 (2005)
  29. Gronchi-Perrin A, "Does subthalamic nucleus deep brain stimulation really improve quality of life in Parkinson’s disease", Mov Disord, 21, pp.1465~1468 (2006)
  30. Schupbach M, "Neurosurgery in Parkinson disease: a distressed mind in a repaired body", Neurology, 66, pp.1811~1816 (2006)
  31. Jenkinson C, "Self-reported functioning and well-being in patients with Parkinson’s disease: comparison of the short-form health survey (SF-36) and the Parkinson’s Disease Questionnaire (PDQ-39)", Age Ageing, 24, pp.505~509 (1995)
  32. Hobson JP, "Is the SF-36 health survey questionnaire suitable as a self-report measure of the health status of older adults with Parkinson’s disease", Qual Life Res, 6, pp.213~216 (1997)
  33. Peto V, "PDQ-39: a review of the development, validation and application of a Parkinson’s disease quality of life questionnaire and its associated measures", J Neurol, 245(1), pp.S10~14 (1998)
  34. Jahanshahi M, "The impact of deep brain stimulation on executive function in Parkinson’s disease", Brain, 123, pp.1142~1154 (2000)
  35. Daniele A, "Cognitive and behavioural effects of chronic stimulation of the subthalamic nucleus in patients with Parkinson’s disease", J Neurol Neurosurg Psychiatry, 74, pp.175~182 (2003)
  36. Alegret M, "Effects of bilateral subthalamic stimulation on cognitive function in Parkinson disease", Arch Neurol, 58, pp.1223~1227 (2001)
  37. Ardouin C, "Bilateral subthalamic or pallidal stimulation for Parkinson’s disease affects neither memory nor executive functions: a consecutive series of 62 patients", Ann Neurol, 46, pp.217~223 (1999)
  38. Perozzo P, "Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: comparison of pre- and postoperative neuropsychological evaluation", J Neurol Sci, 192, pp.9~15 (2001)
  39. Houeto JL, "Behavioural disorders, Parkinson’s disease and subthalamic stimulation", J Neurol Neurosurg Psychiatry, 72, pp.701~707 (2002)

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