Rozprawa doktorska
w chorobie Parkinsona ze
The impact of subthalamic deep brain stimulation on non-
with special
Zdrowiu z Tropikalnej
-Psychiatrycznego
Promotor: Prof. dr hab. n. med.
...
..
.
.
..
DBS
EDS
MRI - imaging)
NMS objawy pozaruchowe (ang. non-motor symptoms)
PD c
PSG polisomnografia (ang. polysomnography)
RBD zaburzenia zachowania podczas snu REM (ang. REM sleep behavior disorder)
REM sen paradoksalny, faza snu, ocznych (ang. rapid eye movement)
RLS
STN
T - Tesla
WASO
STRESZCZENIE
Wprowadzenie
Choroba Parkinsona (PD) jest schorzeniem ym, jednak spektrum w PD jest szerokie i obejmuje objawy
ch h.
jak i -
na objawy pozaruchowe, a sen w
PD leczonych DBS-
. -STN
na
s 40-
nia
dwukrotnie w medianie 6,3 i 12,3
rezonansem magnetycznym (MRI). Uzyskano
go Uniwersytetu Medycznego (NKBBN/54/2014).
Wyniki
Podobnie jak w poprzednich badaniach, stwierdzono -
poziomie. Natomiast, w no
-STN, co znalaz
kontrolnym badaniu PSG. Stwierdzono go czasu snu,
1, czuwanie wowano
de novo
rozpoznanym RLS wyst
programowaniu DBS, nie stwierdzono RBD ani utraty atonii w czasie snu REM u
- P
obserwowano nastroju jednak nie
ono zmian
poznawczych w
ono
(NMS) -
czuciowych,
,
zaobserwowano w zakresie -naczyniowych
(objawy hipotonii ortostatycznej) seksualnych. Nie stwierdzono
parametrami snu. Podobnie do nie stwierdzono korelacji
czy innymi objawami pozaruchowymi. Zaobserwowano istotn
Podsumowanie
DBS-
-
-
dnikiem zmian w architekturze snu.
ABSTRACT
Introduction
P disease (PD) is a primarily motor entity, however, the spectrum of non-motor symptoms (NMS) is wide and includes neuropsychiatric disturbances, cognitive deterioration, sensory symptoms, autonomic dysfunction and sleep and wakefulness disorders. Many studies demonstrated that NMS determine quality of life and are more debilitating than motor symptoms. Among NMS, sleep
disturbances are one of the important contributors to poor quality of life of patients and their caregivers. Subthalamic nucleus (STN) targeted deep brain stimulation (DBS-STN) has a proven beneficial effect on motor symptoms, however, its impact on non-motor problems, and sleep in particular, is not fully understood. Previous sleep studies of PD patients pre- and post-DBS surgery had several limitations such as a short observation period and a small number of participants. The aim of the study was to explore the effects of DBS-STN in PD patients, with special emphasis on sleep and other non-motor symptoms.
Materials and Methods
Thirty six patients, 21 males and 15 females, with advanced PD were enrolled into
the study. -69) and the mean disease
Twenty four were assessed with the use of
polysomnography (PSG) at a median of 1.5 weeks before surgery and again at a median of 6.5 months post DBS programming. The whole group (36 patients) underwent comprehensive evaluation including neurological and
neuropsychological examinations, motor, non-motor symptoms (sleep
disturbances in particular) and quality of life measures, before surgery and twice
at a median of 6.3 and 12.3 months after DBS programming. Additionally, 1.5 T Magnetic Resonance Imaging (MRI) was performed. The written informed consent was collected from all patients and the study was approved by the Bioethics Committee at the Medical University of Gdansk(NKBBN/54/2014).
Results
Consistently with previous studies, improvement of subjective sleep quality after DBS-STN was found, whereas daytime sleepiness remained relatively stable.
However, contrary to the previous studies, deterioration of objective sleep quality after DBS-STN was observed, as was reflected by changes in most parameters at the follow-up PSG evaluation. The reduction of total sleep time, sleep efficiency, the most restoring and recuperative stages of N3, rapid eye movement (REM) and N2 sleep was found, on the other hand, the lightest sleep stage N1, wakefulness after sleep onset (WASO) and latency of sleep were increased. The remission of restless legs syndrome (RLS) symptoms in 43% of patients (6/14) and the new onset of RLS only in 2 patients after DBS were observed. The improvement of RLS symptoms was most prominent in the first 6 months and later slightly diminished. Even though, 21, 13 and 15 patients reported REM sleep behavior disorder (RBD) in questionnaires at baseline, at 6-month and at 12-month follow- up visits, respectively, neither RBD nor the loss of REM atonia was detected in any patient on PSG examinations. Mood improved significantly during the first 6 months after DBS-STN, however, later deteriorated. Although, after 12 months
follow up. Significant improvement of the majority of other non-motor symptoms (NMS), with special emphasis on fatigue, gastrointestinal, bodily discomfort, as well as activities of daily living, perceived social stigma and quality of life was similar to previous reports. Interestingly enough, in contrast to previous studies, significant improvement of perceived severity of cardiovascular and sexual symptoms was found. No relevant and consistent relationships between severity of motor symptoms and objective sleep parameters were observed. Similarly to previous studies, no associations between motor symptoms and subjective sleep measures or other non-motor symptoms were observed. The significant
correlations between subjective sleep disturbances, non-motor symptoms, quality of life and complications of levodopa therapy were found.
Conclusions
In summary, DBS-STN negatively influenced objective sleep parameters, whereas, perceived sleep disturbances improved significantly, as well as other non-motor symptoms and quality of life. The observed subjective improvement was most prominent in the first few months after DBS-STN, later slightly
diminished, which corresponded to changes in mood over time. The present study is the first one to report the relationship between mood and subjective sleep
parameters. e rapid
improvement in the first few months after DBS-STN and the following
deterioration, was most likely due to the concomitant changes in mood. Subjective sleep outcome measures may be influenced by mood changes, whereas PSG remains the main objective parameter, reflecting the changes in sleep architecture.
Wprowadzenie
[1] W krajach upr
ulacji.[1] W
[1]
neur
[2 4] W wielu badaniach wykazano,
ruchowe.[4,5]
PD,
ness) i ataki [6]
-STN, subthalamic
[7,8] Poprzednie badania snu u -
[7 14]
-STN na zaburzenia pozaruchowe u
Hipoteza badawcza pracy
zaburzenia pozaruchowe, w tym zaburzenia snu, w chorobie Parkinsona.
Dulski J
disease September
2015, Pages 147 155. doi:10.1016/j.pin.2015.08.002 MNISW=13 pkt IF=0
Dulski J
ep brain stimulation on
polysomnographic sleep pattern in patients with Parkinson's disease - Preliminary report. Neurologia i Neurochirurgia Polska. 2018 Aug;52(4):514-518. doi:
10.1016/j.pjnns.2018.05.006. Epub 2018 Jun 1.
MNISW=15pkt IF= 0.817
Dulski J
nonmotor symptoms in Parkinson's disease. Parkinsonism and Related Disorders (2019), doi: https://doi.org/10.1016/j.parkreldis.2019.04.001.
MNISW=35pkt IF= 4.721
Podsumowanie badania
DBS-STN pogarsza obiektywne parametry snu, podczas gdy, istotnie poprawia objawy
. Obserwowana subiektywna poprawa jest najbardziej -
zmniejszeniu, co koresponduje z odpowiednimi zmianami nastroju.
jem i subiektywnymi parametrami snu.
-
[1]
Neurol 2006;5:525 35. doi:10.1016/S1474-4422(06)70471-9.
[2] Schapira AHV, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nat Rev Neurosci 2017;18:435 50. doi:10.1038/nrn.2017.62.
[3] Chaudhuri KR, Schapira AHV. Non-
dopaminergic pathophysiology and treatment. Lancet Neurol 2009;8:464 74.
doi:10.1016/S1474-4422(09)70068-7.
[4]
--a cross-sectional study in an outpatient clinic attendees. Parkinsonism Relat Disord 2005;11:465 8.
doi:10.1016/j.parkreldis.2005.04.006.
[5] Peeraully T, Yong M-H, Chokroverty S, Tan E-
disease: a review of case-control polysomnography studies. Mov Disord Off J Mov Disord Soc 2012;27:1729 37. doi:10.1002/mds.25197.
[6] Menza M, Dobkin RD, Marin H, Bienfait K. Sleep disturbances in
1:S117-122. doi:10.1002/mds.22788.
[7] Sharma VD, Sengupta S, Chitnis S, Amara AW. Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review. Front Neurol 2018;9:697. doi:10.3389/fneur.2018.00697.
[8] Amara AW, Watts RL, Walker HC. The effects of deep brain stimulation on
[9] Monaca C, Ozsancak C, Jacquesson JM, Poirot I, Blond S, Destee A, et al.
Neurol 2004;251:214 8. doi:10.1007/s00415-004-0305-7.
[10] Cicolin A, Lopiano L, Zibetti M, Torre E, Tavella A, Guastamacchia G, et al. Effects of deep brain stimulation of the subthalamic nucleus on sleep architecture in parkinsonian patients. Sleep Med 2004;5:207 10.
doi:10.1016/j.sleep.2003.10.010.
[11] Arnulf I, Bejjani BP, Garma L, Bonnet AM, Houeto JL, Damier P, et al.
Improvement of sleep architecture in PD with subthalamic nucleus stimulation. Neurology 2000;55:1732 4.
[12] Iranzo A, Valldeoriola F, Santamaria J, Tolosa E, Rumia J. Sleep symptoms and polysomnographic architecture i
disease after chronic bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002;72:661 4. doi:10.1136/jnnp.72.5.661.
[13] Nishida N, Murakami T, Kadoh K, Tohge R, Yamanegi M, Saiki H, et al.
Subthalamic nucleus deep brain stimulation restores normal rapid eye
2011;26:2418 22. doi:10.1002/mds.23862.
[14] Baumann-
Baumann CR, et al. The Impact of Subthalamic Deep Brain Stimulation on Sleep-Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients. Sleep 2017;40. doi:10.1093/sleep/zsx033.
1) Publikacja
https://doi.org/10.1016/j.pin.2015.08.002 2)
polysomnographic sleep pattern in patients with Parkinson's disease -
https://doi.org/10.1016/j.pjnns.2018.05.006
3) stimulation on sleep
https://doi.org/10.1016/j.parkreldis.2019.04.001
