Deep Brain Stimulation for Freezing of Gait in Parkinson's Disease With Early Motor Complications

被引：53

作者：

Barbe, Michael T. ^{[1
,2
]}

Tonder, Lisa ^{[3
]}

Krack, Paul ^{[4
,5
]}

Debu, Bettina ^{[6
,7
]}

Schupbach, Michael ^{[4
,5
,8
,9
,10
]}

Paschen, Steffen ^{[11
]}

Dembek, Till A. ^{[1
,2
]}

Kuehn, Andrea A. ^{[12
]}

Fraix, Valerie ^{[6
,7
,13
]}

Brefel-Courbon, Christine ^{[14
]}

Wojtecki, Lars ^{[15
,16
]}

Maltete, David ^{[17
,18
,19
]}

Damier, Phillippe ^{[20
]}

Sixel-Doering, Friederike ^{[21
]}

Weiss, Daniel ^{[22
,23
]}

Pinsker, Marcus ^{[24
]}

Witjas, Tatiana ^{[25
]}

Thobois, Stephane ^{[26
,27
]}

Schade-Brittinger, Carmen ^{[28
]}

Rau, Joern ^{[28
]}

Houeto, Jean-Luc ^{[29
]}

Hartmann, Andreas ^{[8
,9
]}

Timmermann, Lars ^{[1
,30
]}

Schnitzler, Alfons ^{[15
,16
]}

Stoker, Valerie ^{[3
]}

Vidailhet, Marie ^{[31
]}

Deuschl, Guenther ^{[11
]}

Knudsen, K. ^{[32
,33
]}

Volkmann, J. ^{[32
,33
]}

Falk, D. ^{[32
,33
]}

Mehdorn, M. ^{[32
,33
]}

Haelbig, T. D. ^{[34
,35
]}

Hesekamp, H. ^{[34
,35
]}

Navarro, S. M. ^{[34
,35
]}

Meier, N. ^{[34
,35
]}

Agid, Y. ^{[34
,35
]}

Seigneuret, E. ^{[36
,37
]}

Kistner, A. ^{[36
,37
]}

Chaynes, P. ^{[36
,37
]}

Ory-Magne, F. ^{[38
]}

Bataille, B. ^{[39
]}

Raoul, S. ^{[40
]}

Regis, J. -M. ^{[41
]}

Mertens, P. ^{[42
]}

Helwig, D. ^{[43
,44
]}

Oertel, W. H. ^{[43
,44
]}

Maarouf, M. ^{[45
,46
]}

Fink, G. R. ^{[45
,46
]}

Kupsch, A. ^{[47
,48
]}

Gruber, D. ^{[47
,48
]}

机构：

[1] Univ Cologne, Fac Med, Dept Neurol, Cologne, Germany

[2] Univ Cologne, Univ Hosp Cologne, Cologne, Germany

[3] Medtronic, Minneapolis, MN USA

[4] Univ Hosp Bern, Dept Neurol, Bern, Switzerland

[5] Univ Bern, Bern, Switzerland

[6] Univ Grenoble Alpes, Grenoble Inst Neurosci, INSERM 1216, Grenoble, France

[7] Grenoble Univ Hosp, Dept Neurol, Grenoble, France

[8] Univ Pierre & Marie Curie Paris 6, AP HP, Ctr Invest Clin 9503, Inst Cerveau & Moelle Epiniere,Dept Neurol, Paris, France

[9] CHU Pitie Salpetriere, INSERM, Paris, France

[10] Inst Neurol, Konolfingen, Switzerland

[11] UKSH, Dept Neurol, Kiel Campus Christian Albrechts University, Kiel, Germany

[12] Charite Univ Med Berlin, Dept Neurol, Campus Mitte, Berlin, Germany

[13] Grenoble Univ Hosp, Dept Neurol, Grenoble, France

[14] Univ Hosp Toulouse, Dept Neurol, INSERM, Unite 1214, Toulouse, France

[15] Heinrich Heine Univ Duesseldorf, Inst Clin Neurosci & Med Psychol, Dusseldorf, Germany

[16] Heinrich Heine Univ Duesseldorf, Dept Neurol, Dusseldorf, Germany

[17] Rouen Univ Hosp, Dept Neurol, Rouen, France

[18] Univ Rouen, Rouen, France

[19] INSERM, U1239, Lab Neuronal & Neuroendocrine Differentiat & Comm, Mont St Aignan, France

[20] CHU Nantes, Hop Laennec, INSERM, CIC1413, Nantes, France

[21] Paracelsus Elena Klin Kassel, Kassel, Germany

[22] Univ Tubingen, Dept Neurodegenerat Dis, Ctr Neurol, Tubingen, Germany

[23] Univ Tubingen, Hertie Inst Clin Brain Res, Tubingen, Germany

[24] Univ Med Ctr, Div Stereotact & Funct Neurosurg, Freiburg, Germany

[25] Timone Univ Hosp, Dept Neurol, CNRS Marseille, UMR 7289, Marseille, France

[26] Hosp Civils Lyon, Hop Neurol Pierre Wertheimer, Serv Neurol C, Ctr Expert Parkinson, Bron, France

[27] Univ Claude Bernard Lyon 1, Univ Lyon, Fac Med Lyon Sud Charles Merieux, Oullins, France

[28] Philipps Univ, Coordinating Ctr Clin Trials, Marburg, Germany

[29] Univ Poitiers, CHU Poitiers, Dept Neurol, CIC INSERM 1402, Poitiers, France

[30] Univ Klinikum Giessen & Marburg, Marburg Campus, Marburg, Germany

[31] Sorbonne Univ, Salpetriere Univ Hosp, AP HP, ICM UMR1127,INSERM & 1127,CNRS 7225,Dept Neurol, Paris, France

[32] Univ Hosp Schleswig Holstein, Dept Neurol, Kiel, Germany

[33] Univ Hosp Schleswig Holstein, Dept Neurosurg, Kiel, Germany

[34] Univ Pierre & Marie Curie Paris 6, AP HP, Ctr Invest Clin 9503, Dept Neurol & Neurochirurg,Inst Cerveau & Moelle, Paris, France

[35] CHU Pitie Salpetriere, INSERM, Paris, France

[36] Univ Hosp, INSERM, Unite 836, Dept Neurol, Grenoble, France

[37] Univ Hosp, INSERM, Unite 836, Dept Neurosurg, Grenoble, France

[38] Univ Hosp, Dept Neurol Neurosurg & Pharmacol, Toulouse, France

[39] Univ Poitiers, Dept Neurosurg, Poitiers, France

[40] CHU Nantes, CIC, Nantes, France

[41] Aix Marseille Univ, Dept Funct Neurosurg, Marseille, France

[42] Univ Hosp Lyon, Hop Neurol Pierre Wertheimer, Dept Neurosurg, Lyon, France

[43] Philipps Univ, Dept Neurosurg, Marburg, Germany

[44] Philipps Univ, Dept Neurol, Marburg, Germany

[45] Univ Cologne, Dept Neurol, Cologne, Germany

[46] Univ Cologne, Dept Neurosurg, Cologne, Germany

[47] Charite Campus Virchow Hosp, Dept Neurol, Berlin, Germany

[48] Charite Campus Virchow Hosp, Dept Neurosurg, Berlin, Germany

[49] Heinrich Heine Univ, Dept Neurosurg, Dusseldorf, Germany

[50] Heinrich Heine Univ, Dept Neurol, Dusseldorf, Germany

来源：

MOVEMENT DISORDERS | 2020年 / 35卷 / 01期

关键词：

axial signs; deep brain stimulation; EARLYSTIM; freezing of gait; SUBTHALAMIC NUCLEUS STIMULATION; MEDICAL THERAPY; FOLLOW-UP; NEUROSTIMULATION; LEVODOPA; MULTICENTER; TRIAL;

D O I：

10.1002/mds.27892

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background Effects of DBS on freezing of gait and other axial signs in PD patients are unclear. Objective Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complications (EARLYSTIM-trial). Methods One hundred twenty-four patients were randomized in the stimulation group and 127 patients in the best medical treatment group. Presence of freezing of gait was assessed in the worst condition based on item-14 of the UPDRS-II at baseline and follow-up. The posture, instability, and gait-difficulty subscore of the UPDRS-III, and a gait test including quantification of freezing of gait and number of steps, were performed in both medication-off and medication-on conditions. Results Fifty-two percent in both groups had freezing of gait at baseline based on UPDRS-II. This proportion decreased in the stimulation group to 34%, but did not change in the best medical treatment group at 24 months (P = 0.018). The steps needed to complete the gait test decreased in the stimulation group and was superior to the best medical treatment group (P = 0.016). The axial signs improved in the stimulation group compared to the best medical treatment group (P < 0.01) in both medication-off and medication-on conditions. Conclusions Within the first 2 years of DBS, freezing of gait and other axial signs improved in the medication-off condition compared to best medical treatment in these patients. (c) 2019 International Parkinson and Movement Disorder Society

引用

页码：82 / 90

页数：9

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