Abstract:

Objective: To focus on the efficacy at variable frequency stimulation (VFS) after deep brain stimulation (DBS) for the treatment of axial symptoms in Parkinson's disease (PD). Methods: Clinical data of 12 patients with PD who underwent bilateral DBS followed by VFS more than one year from January 2018 to June 2022 at Tianjin Huanhu Hospital, Tianjin University were retrospectively analyzed. Axial symptoms were assessed using Unified Parkinson's Disease Rating Scale (UPDRS)-gait posture, Timed Up and Go Test (TUGT) time and the occurrence of freezing of gait (FOG), The Freezing of Gait-Questionnaire (FOG-Q), and Berg Balance Scale (BBS). The above indicators were recorded one week before DBS surgery and in the drug "off" period (baseline), at the end of high frequency stimulation (the end of HFS), at one month follow-up of VFS (short-term VFS), and at one year or more follow-up of VFS (long-term VFS). Results: Compared with baseline, BBS scores increased at the end of HFS (t =-2.845, P = 0.008); UPDRS-gait posture (t = 12.703, P = 0.000; t = 11.737, P = 0.000), TUGT time (t = 8.923, P = 0.000; t = 8.025, P = 0.000) and the occurrence of FOG (t = 4.448, P = 0.000; t = 4.181, P = 0.000), and FOG-Q scores (t = 9.186, P = 0.000; t = 8.186, P = 0.000) decreased, while the BBS scores increased (t =-7.686, P = 0.000; t =-6.106, P = 0.000) in both short-term VFS and long-term VFS. Compared with the end of HFS, UPDRS-gait posture (t = 11.583, P = 0.000; t = 10.618, P = 0.000), TUGT time (t = 6.922, P = 0.000; t = 6.022, P = 0.000) and the occurrence of FOG (t = 3.612, P = 0.001; t = 3.344, P = 0.002), and FOG-Q scores (t = 7.915, P = 0.000; t = 6.915, P = 0.000) decreased, while the BBS scores increased (t = -4.842, P = 0.000; t =-3.262, P = 0.003) in short-term VFS and long-term VFS. Conclusions: For PD patients with HFS but poor axial symptoms efficacy after DBS, the use of VFS significantly improves multifaceted axial symptoms with reliable long-term efficacy.

Key words: Parkinson disease, Deep brain stimulation, Subthalamic nucleus, Motor disorders

摘要：

目的: 重点探讨脑深部电刺激术后采用变频刺激模式治疗帕金森病轴性症状的疗效。方法: 回顾分析天津大学环湖医院2018年1月至2022年6月接受双侧脑深部电刺激术并于术后采用变频模式刺激1年以上的12例帕金森病患者的临床资料。轴性症状的评估采用统一帕金森病评价量表（UPDRS）-步态姿势、起立-行走计时测试（TUGT）时间及冻结步态次数、冻结步态问卷（FOG-Q）、Berg平衡量表（BBS）。并记录脑深部电刺激术前1周且处于药物“关”期（基线），高频刺激结束时（HFS结束）、变频刺激随访1个月（VFS短期）、变频刺激随访1年及以上（VFS长期）上述指标。结果: 与基线相比，HFS结束患者BBS评分增加（t=-2.845，P=0.008）；VFS短期和VFS长期患者UPDRS-步态姿势（t=12.703，P=0.000；t=11.737，P=0.000）、TUGT-时间（t=8.923，P=0.000；t=8.025，P=0.000）、TUGT-冻结步态次数（t=4.448，P=0.000；t=4.181，P=0.000）、FOG-Q评分（t=9.186，P=0.000；t=8.186，P=0.000）均减少，BBS评分增加（t=-7.686，P=0.000；t=-6.106，P=0.000）。与HFS结束相比，VFS短期和VFS长期患者UPDRS-步态姿势（t=11.583，P=0.000；t=10.618，P=0.000）、TUGT-时间（t=6.922，P=0.000；t=6.022，P=0.000）、TUGT-冻结步态次数（t=3.612，P=0.001；t=3.344，P=0.002）、FOG-Q评分（t=7.915，P=0.000；t=6.915，P=0.000）均减少，BBS评分增加（t=-4.842，P=0.000；t=-3.262，P=0.003）。结论: 对于脑深部电刺激术后采用高频刺激但轴性症状疗效欠佳的帕金森病患者，采用变频刺激后可显著改善多种轴性症状，且长期疗效可靠。

关键词: 帕金森病, 深部脑刺激法, 丘脑底核, 运动障碍