| 总结: | <p><b>Study</b></p>
Deep Brain Stimulation for Autonomic and Gait Symptoms in Multiple System Atrophy.</p>
<p><b>Introduction</b></p>
Multiple system atrophy is a relentlessly progressive and disabling chronic neurodegenerative disorder. There are currently no known disease modifying treatments, and all available therapy is currently aimed at symptomatic relief.</p>
<p>Pedunculopontine nucleus DBS has been shown in patients with Parkinson’s disease to abrogate some of the symptoms that are also commonly seen in MSA: specifically, freezing of gait, postural instability, orthostatic hypotension, and urinary problems.</p>
<p>There has never been a trial of pedunculopontine nucleus deep brain stimulation for multiple system atrophy performed. The current study aims to assess whether or not bilateral pedunculopontine nucleus deep brain stimulation is safe in MSA, and if it improves gait and autonomic symptoms in these patients, thereby improving their quality of life.</p>
<p><b>Study Design</b></p>
<p>Five patients with parkinsonian subtype MSA that were fit to undergo surgical intervention were recruited, after independent confirmation of clinical diagnosis by two consultant neurologists with a specialist interest in movement disorders, with all patients satisfying the diagnostic criteria of MSA. The patients underwent a battery of gait and autonomic tests and questionnaires before undergoing bilateral PPN DBS. These tests were then repeated after a period of chronic DBS.</p>
<p><b>Results</b></p>
<p>Some of the symptoms of MSA, are improved to some extent by deep brain stimulation. Overall, despite modest improvement in autonomic physiological parameters, there was no significant or sustained improvement in quality of life. </p>
<p>Some of the follow-up time points were delayed or missed due to the coronavirus pandemic, and so beneficial effects of DBS in the shorter term may have been masked by disease progression in those patients – particularly since those patients proved to have a more aggressive disease course.</p>
<p><b>Conclusions</b></p>
<p>PPN DBS is safe in the context of MSA. It may help with some of the symptoms suffered by MSA patients, although these effects are modest in magnitude, and may not justify the risk of surgery. The disease remains relentlessly progressive, and any beneficial effects of DBS are therefore short-lived.
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