Yokoyama T, Sugiyama K, Nishizawa S, Yokota N, Ohta S, Uemura K
Department of Neurosurgery, Hamamatsu University School of Medicine, Japan.
Neurosurgery. 1999 Jul;45(1):41-7; discussion 47-9. doi: 10.1097/00006123-199907000-00011.
A preliminary study of subthalamic nucleus (STN) stimulation was performed to determine its applicability for the treatment of gait and postural disturbances in Parkinson's disease.
Five Parkinson's disease patients with freezing gait and postural instability were selected for this study. Their ages ranged from 60 to 73 years (mean+/-standard deviation, 65.6+/-4.8 years). Semi-microelectrode recording was used to identify the STN and to place a chronic electrical stimulation electrode within the right STN in all patients. The Unified Parkinson's Disease Rating Scale and the modified Hoehn and Yahr Staging Scale were used to assess patients in on- and off-drug conditions before surgery and 3 months after surgery.
The scores on the Hoehn and Yahr Staging Scale and the total Unified Parkinson's Disease Rating Scale for akinesia (P < 0.05), gait (P < 0.05), and gait and posture (P < 0.01) in off-drug on-stimulation conditions significantly improved over the preoperative and postoperative off-drug off-stimulation conditions (analysis of variance [ANOVA], P < 0.01). Improvement over the preoperative scores was 24% on the Hoehn and Yahr Staging Scale, 43.6% on the total Unified Parkinson's Disease Rating Scale, 33.4% for akinesia, 36.6% for gait, and 38.7% for gait and posture. However, stimulation in the on-drug phase did not show a significant difference compared with pre- and postoperative conditions (ANOVA, P > 0.05). Comparisons between preoperative on-drug and postoperative off-drug on-stimulation conditions revealed that there were no significant differences in the scores, except for gait (ANOVA, P < 0.05). The scores on subscales for falling, freezing, walking, and gait in off-drug on-stimulation conditions were significantly improved over the scores for preoperative and postoperative off-stimulation (ANOVA, P < 0.05), but the score for postural stability remained unchanged.
Our findings showed that STN stimulation effectively alleviates freezing gait and improves walking to its status during the preoperative on-drug phase and can be applied for treatment of Parkinson's disease patients with these symptoms.
对丘脑底核（STN）刺激进行初步研究，以确定其在治疗帕金森病步态和姿势障碍方面的适用性。
选取5例患有冻结步态和姿势不稳的帕金森病患者进行本研究。他们的年龄在60至73岁之间（平均±标准差，65.6±4.8岁）。所有患者均采用半微电极记录法来识别STN，并在右侧STN内植入慢性电刺激电极。采用统一帕金森病评定量表和改良的Hoehn和Yahr分期量表，在术前及术后3个月对患者服药和未服药状态下进行评估。
在未服药刺激状态下，Hoehn和Yahr分期量表评分以及统一帕金森病评定量表中运动不能（P<0.05）、步态（P<0.05）、步态和姿势（P<0.01）的总分，与术前及术后未服药未刺激状态相比有显著改善（方差分析[ANOVA]，P<0.01）。与术前评分相比，Hoehn和Yahr分期量表改善了24%，统一帕金森病评定量表总分改善了43.6%，运动不能改善了33.4%，步态改善了36.6%，步态和姿势改善了38.7%。然而，服药期刺激与术前及术后状态相比无显著差异（ANOVA，P>0.05）。术前服药与术后未服药刺激状态之间的比较显示，除步态外（ANOVA，P<0.05），评分无显著差异。未服药刺激状态下跌倒、冻结、行走和步态子量表的评分与术前及术后未刺激评分相比有显著改善（ANOVA，P<0.05），但姿势稳定性评分保持不变。
我们的研究结果表明，STN刺激可有效缓解冻结步态，并将步行能力改善至术前服药期的状态，可用于治疗有这些症状的帕金森病患者。
