Determinants of Functional Independence or Its Loss following Subthalamic Nucleus Stimulation in Parkinson's Disease
- 주제(키워드) Parkinson's disease , Deep brain stimulation , Activities of daily living , Dependence , Independence
- 주제(기타) Neurosciences
- 주제(기타) Neuroimaging
- 주제(기타) Surgery
- 설명문(일반) [Kim, Ryul; Yoo, Dallah; Kim, Han-Joon; Jeon, Beomseok] Seoul Natl Univ, Seoul Natl Univ Hosp, Coll Med, Dept Neurol, Seoul, South Korea; [Jung, Yu Jin] Catholic Univ Korea, Daejeon St Marys Hosp, Coll Med, Dept Neurol, Seoul, South Korea; [Lee, Woong-Woo] Eulji Univ, Nowon Eulji Med Ctr, Dept Neurol, Seoul, South Korea; [Ehm, Gwanhee] Natl Med Ctr, Dept Neurol, Seoul, South Korea; [Yun, Ji Young] Ewha Womans Univ, Sch Med, Seoul Hosp, Dept Neurol, Seoul, South Korea; [Kim, Hee Jin] Konkuk Univ, Sch Med, Med Ctr, Dept Neurol, Seoul, South Korea; [Lee, Jee-Young] Seoul Natl Univ, Coll Med, Seoul Metropolitan Govt Boramae Med Ctr, Dept Neurol, Seoul, South Korea; [Kim, Ji-Young] Inje Univ, Seoul Paik Hosp, Dept Neurol, Seoul, South Korea; [Paek, Sun Ha] Seoul Natl Univ, Coll Med, Seoul Natl Univ Hosp, Dept Neurosurg, Seoul, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 KARGER
- 발행년도 2019
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000172026
- 본문언어 영어
- Published As https://dx.doi.org/10.1159/000500277
- PubMed https://pubmed.ncbi.nlm.nih.gov/31266044
초록/요약
Objective: This study aimed to describe the change in functional status following bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) and to identify predictors of postoperative functional dependence. Methods: We included PD patients with bilateral STN-DBS who had complete Schwab & England Activities of Daily Living (S&E ADL) Scale data at baseline and 6 months after surgery from our prospective registry. Functional dependence was defined as an S&E ADL score of less than 80%. All data were collected from the on-medication state and on-stimulation state (after surgery). Logistic regression analyses were performed to determine the factors predictive of functional dependence after surgery. Results: A total of 196 patients were included. At baseline, 41 patients were functionally dependent and the other 155 were functionally independent. Among the patients with preoperative dependence, 32 (78%) became functionally independent after surgery, and this conversion was associated with a lower baseline axial score (p = 0.012). Among the patients with preoperative independence, 21 (14%) developed postoperative dependence, and this conversion was associated with a higher baseline axial score (p = 0.013) and its smaller improvement (p < 0.001). Female sex (odds ratio [OR] 3.214; 95% confidence interval [CI] 1.210-8.542; p = 0.019) and a higher baseline axial score (OR 1.184; 95% CI 1.056-1.327; p = 0.004) significantly predicted the risk of postoperative functional dependence. Conclusions: We found that functional status following bilateral STN-DBS is closely related to preoperative axial symptoms. When loss of independence is a potential target for STN-DBS, clinicians should take into consideration the severity of axial impairment before surgery. (C) 2019 S. Karger AG, Basel
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