Artikel
Immediate effects of deep brain stimulation of the subthalamic nucleus on nonmotor symptoms in Parkinson's disease
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Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: To assess the immediate effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) on nonmotor symptoms (NMS) in Parkinson's disease (PD).
Background:Immediate effects of STN-DBS on motor functions are well accepted, but similar data on NMS are mainly lacking. However, a few studies reported fluctuations of NMS in conjunction with motor oscillations in advanced PD without STN-DBS.
Methods: 34 PD patients, who received bilateral STN-DBS were examined in medication off state for frequency and severity of 10 NMS (swallowing problems, anxiety, depression, fatigue, excessive sweating, inner restlessness, pain, concentration/attention, dizziness, bladder urgency) using a visual analog scale (VAS) with STN-DBS off and on. Motor assessments were done using UPDRSIII.
Results: Independent of the STN-DBS status, the most frequent NMS was fatigue (85% of patients), followed by problems with concentration/attention (71%) and inner restlessness (53%). The incidence of most NMS were similar in both STN-DBS groups, while only inner restlessness was significantly decreased by STN-DBS. In contrast, the severity of all NMS except excessive sweating, pain and dizziness were significantly improved by STN-DBS, but only a small proportion of patients (3–24% of patients depending on the NMS) showed relevant improvement (> 10% on VAS). There were no correlations of severity improvements of NMS with motor improvement, demographic data and medication.
Conclusions: STN-DBS does not have major immediate effects on the incidence of NMS, but improves most NMS, particularly psychiatric symptoms such as depression, anxiety and fatigue in a subset of patients. There is no indication that STN-DBS worsens NMS.