文摘
摘要目的:确定频率和预测的改善和恶化冷漠的参与者接受双边丘脑脑深部电刺激(STN-DBS)治疗帕金森病(PD)是无畏的随机对照试验的一部分。
背景:许多研究表明,冷漠可以与多巴胺能神经支配和可能被停药和积极的药物STN-DBS手术后逐渐减少。此外,它被怀疑的刺激limbic-associative次区域STN可能作为一个催化剂,一个独立的原因或与减少多巴胺能药物协同作用。
设计/方法:无畏的(ClinicalTrials.gov:NCT01839396)是一个多中心,前瞻性,双盲,随机对照试验。参与者与先进的PD收到双边STN-DBS和完成了神经心理学电池在筛查(DBS)和跟进(12个月)。冷漠是评估使用Starkstein冷漠量表(SAS)。人口和临床资料,包括年龄、性别、疾病持续时间、疾病严重程度、levodopa-equivalent日剂量(LEDD)和DBS成像相关(包括位置和体积的刺激组织)进行了分析。
结果:总共有160名受试者评估STN-DBS后1年,44(27.5%)报告的改善冷漠的至少5分,和7(4.4%)> 10分的改进。18(11.3%)参与者恶化冷漠分数> 5分,恶化和8(5%)> 10分。聚合的刺激领域模型(SFM)在整个军团,表明恶化的冷漠与激活STN的边缘和关联领域。
结论:双边STN-DBS在一个未来的大数据集显示改善和恶化的冷漠在1年期后续访问。进一步分析LEDD,多巴胺受体激动剂使用,和体积的组织激活可能帮助我们理解支撑冷漠DBS后的临床因素。适当的术前咨询加上术后监测很重要对设定的期望和必要时采用适当的治疗。
披露:Stiep博士没有披露。拉米雷斯扎莫拉博士已经收到个人薪酬在500 - 4999美元的范围为中枢神经系统评级作为顾问。拉米雷斯扎莫拉博士已经收到个人薪酬在10000 - 49999美元的范围为美敦力公司担任顾问。拉米雷斯扎莫拉博士已经收到个人薪酬在500 - 4999美元的范围为ρ公司担任顾问。拉米雷斯扎莫拉博士已经收到个人薪酬在500 - 4999美元的范围作为Signant健康顾问。拉米雷斯扎莫拉博士的机构已经接到帕金森氏病的基础研究支持。Troster博士已经收到个人薪酬在500 - 4999美元的范围为美敦力公司担任顾问。Troster博士已经收到个人薪酬在500 - 4999美元的范围为武田担任顾问。Troster博士已经收到个人薪酬在500 - 4999美元的范围为圣人疗法作为顾问。Troster博士已经收到个人薪酬在500 - 4999美元的范围作为一个编辑,副主编、编辑顾问委员会成员为剑桥大学出版社/国际社会神经心理学。Troster博士的机构已经接到巴罗神经学基础研究支持。 Dr. Troster has received publishing royalties from a publication relating to health care. Roshini Jain has received personal compensation for serving as an employee of Boston Scientific. Roshini Jain has received stock or an ownership interest from Boston Scientific. Lilly Chen has received personal compensation for serving as an employee of Boston Scientific . Mahsa Malekmohammadi has received personal compensation for serving as an employee of Boston Scientific. Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.
