脳深部刺激療法周術期パーキンソン病患者の非運動症状—5症例からの検証

Non-motor symptoms in Parkinson's disease patients during perioperative period of deep brain stimulation surgery: A five-cases study

要旨：パーキンソン病(Parkinson's Disease；以下，PD)患者の脳深部刺激療法(Deep Brain Stimulation；以下，DBS)周術期の非運動症状の特徴を検証するために視床下核と淡蒼球内節への試験的刺激を経て標的部位を決定するDBSを施行されたPD患者5例の周術期の認知機能と行動精神症状を調査した．結果，外科的処置前と比較して視床下核刺激時にのみ前頭葉機能の習慣的反応抑制と関連する語頭音の語流暢性課題成績の低下を示し，外科的処置後にせん妄様の行動精神症状が5例中4例に観察された．この結果は，DBS周術期PD患者への作業療法の実践には，運動症状だけでなく病棟の行動管理を含めた非運動症状も考慮する必要性を提案している．

　To examine the characteristics of non-motor symptoms in patients with Parkinson's disease (PD) during the perioperative period of deep brain stimulation (DBS), we investigated cognitive functions and behavioral symptoms in five PD patients who underwent DBS to determine the target site via experimental stimulation of the subthalamic nucleus (STN) and the globus pallidus internus (GPi). The results showed a significant decrease in the phonemic verbal fluency task performance involving inhibition of habitual responses only during stimulation of the STN compared to before surgery, and delirium-like behavioral symptoms were observed in 4 of 5 patients after surgery. These results suggest the need for occupational therapy for perioperative PD patients with DBS that considers motor symptoms and non-motor symptoms, including behavior management in the ward.