Effects Of Bilateral Subthalamic Nucleus Deep Brain Stimulation On On-off Phenomenon Of Motor Symptoms In Parkinson’s Disease

[Background]:Parkinson’s disease(PD)is a common,gradually developmental and chronic degenerative disease.It involves the whole brain of central nervous system.The main symptoms are static tremor,bradykinesia,myotonia and abnormal gait posture.Parkinson’s disease is mainly treated with medications combining with operations.And it often needs to be combined with rehabilitation.Non-medication therapy and medical therapy are the early and medium treatments.Surgical interventions are often required in middle and late treatment.And medical therapy is still needed after operations.[Objective]:To follow up the Parkinson’s disease patients in the middle-late period who accepted the bilateral subthalamic nucleus deep brain stimulation surgeries in the first affiliated hospital of guangzhou medical university after operation.To assess the extents of improvement of motor scores on postoperative patients who were on the "off" states(drug "off" and machine "on")and "on" states(drugs "on" and machine "on")with the UPDRS scales.To study and explore the effects of the bilateral subthalamic nucleus deep brain stimulation for Parkinson’s disease patients who were on the "on-off" status.[Method]:The datas were collected from 50 Parkinson’s disease patients who were taken in the bilateral subthalamic nucleus deep brain stimulations in the neurosurgery department of the first affiliated hospital of guangzhou medical university from March 2008 to May 2016,and they were followed up after operations;All the Parkinson’s disease patients who were taken in the bilateral subthalamic nucleus deep brain stimulations were followed up for at least 2 years after operations;2 of them were followed up for 10 years after operations.To assess the score on Parkinson’s disease patients who were on the "off" states(drug "off" and machine "on")and "on" states(drugs "on" and machine "on")with the UPDRS-Ⅲ scales for 3 months,6 months,12 months,2 years,3-5 years and 5-10 years after operations,and then to compare with the score of preoperations respectively.[Results]:On the "off" states,there was a significant improvement in the UPDRS-Ⅲ score observed during 3 months,6 months,12 months,2 years and 3-5 years post-operative follow up compared with the pre-operative UPDRS-Ⅲ score(P<0.05),and there was a reduction of 40.2%,54.4%,57%,40.6% and 40.8% respectively for the UPDRS-Ⅲ score.There was no significant change in the UPDRS-Ⅲ score between pre-operations and 5-10 years after operations(P>0.05).On the "on" states,there was a significant improvement in the UPDRS-Ⅲ score observed during 3 months,6 months and 12 months post-operative follow up compared with the pre-operative UPDRS-Ⅲ score(P<0.05),and there was a reduction of 26.2%,29.6% and 38.2% respectively for the UPDRS-Ⅲ score.There was a growth of 64.9% for the UPDRS-Ⅲ score observed during 5-10 years post-operative follow up compared with the pre-operative UPDRS-Ⅲ score(P<0.05).There was no significant change in the UPDRS-Ⅲ score between pre-operations and 2 and 3-5 years after operations(P>0.05).The average daily dose of levodopa was 953.2 mg which was reduced to 569.76 mg and 570.76 mg respectively at 3 monthsand 6 months after operations with a 40% reduction.In the 12 th month post-operative follow-up,the dosage was reduced to 450.63 mg by almost 53%.[Conclusion]:The results were showed that on the "off" states,there was a significant improvement in the UPDRS-Ⅲ score observed during 3 months,6 months,12 months,2 years and 3-5 years post-operative follow up compared with the pre-operative UPDRS-Ⅲ score.There was a reduction after 3-5 years after operations and the UPDRS-Ⅲ score was decreased to pre-operative levels at 5-10 years after operations.On the "on" states,there was a significant improvement in the UPDRS-Ⅲ score observed during 3 months,6 months and 12 months post-operative follow up compared with the pre-operative UPDRS-Ⅲ score.There was a reduction after 1 year after operations and the UPDRS-Ⅲ score was decreased to pre-operative levels at 3-5 years after operations.There was a growth for the UPDRS-Ⅲ score observed during 5-10 years post-operative follow up compared with the pre-operative UPDRS-Ⅲ score.There was a reduction in the average daily dose of levodopa observed during 1 year post-operative follow-up compared with pre-operations.