パーキンソン病に対する脳深部刺激(DBS:deep brain stimulation)前後の排尿状態の変化について

Abstract

subthalmic nucleus(STN)に対する脳深部刺激(DBS)前後で排尿状態の変化を確認し, STNと排尿の関係について検討した。パーキンソン病患者(男性4名, 女性2名, 平均65.8歳)を対象にした結果, 1)Unified Parkinson's disease Rating Scale(UPDRS)は平均46.5から25.67へ低下し改善を認めた。2)International Prostate Symptom Score(IPSS) totalでは平均11.2から7へと有意に改善を認め, QOL scoreは平均3.7から3.4に低下した。3)Pressure flow study(PFS)では不随性排尿筋収縮閾値容量は平均90.7mlから172.7mlに, 最大膀胱容量が平均104mlから177.2mlと有意に増大した。また, 最大尿流時排尿筋圧は平均60.5cmH2Oから平均51.3cmH2Oと低下した。

Electric stimulation therapy is one of the surgical treatments for Parkinson's disease whereby a chronic stimulating electrode is placed on the subthalmic nucleus (STN). Because medical treatments centered around L-dopa have limitations in severe Parkinson's disease, electric stimulation therapy is regarded as an appropriate treatment modality. Most Parkinson's disease patients experience lower urinary tract disorders such as urgency, daytime frequency or nocturia, due to detrusor overactivity. We conducted an International Prostate Symptom Score (IPSS) analysis and a pressure flow study (PFS) on 6 patients before and after a chronic stimulating electrode was placed on the STN and evaluated how the subjective symptoms and bladder functions changed. As a result, the IPSS total value, involuntary detrusor contraction threshold volume and maximum bladder capacity were all found to significantly improve (P<0.05). The average IPSS decreased from 11.2 to 7.0. The average involuntary detrusor contraction threshold volume increased from 90.7 ml to 172.7 ml. The average maximal bladder capacity increased from 104.0 ml to 177.2 ml. These findings suggest that the STN the positively contributes to an improvement in urinary function.