Kumar R, Lozano A M, Sime E, Halket E, Lang A E
Division of Neurology, University of Toronto, Ontario, Canada.
Neurology. 1999 Aug 11;53(3):561-6. doi: 10.1212/wnl.53.3.561.
To compare the effects of unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) with bilateral STN DBS in advanced PD.
Our initial 10 consecutive patients with medication-refractory motor fluctuations and levodopa-induced dyskinesias undergoing chronic bilateral STN DBS underwent a standardized evaluation of unilateral and bilateral STN DBS in the medication-off state 6 to 18 months after electrode implantation.
Bilateral STN DBS improved the mean total Unified Parkinson's Disease Rating Scale motor score by 54%, whereas unilateral stimulation improved motor scores only 23%. Unilateral STN DBS improved postural stability and gait 14%, other axial motor features 19%, and overall parkinsonism in limbs contralateral to stimulation by 46%, including an 86% improvement in contralateral tremor. However, bilateral STN DBS resulted in greater improvement in each of these domains, including limb function, i.e., the reduction in scores from the limbs on one side was greater with bilateral than with unilateral stimulation of the contralateral STN.
Bilateral STN DBS improves parkinsonism considerably more than unilateral STN DBS; bilateral simultaneous electrode implantation may be the most appropriate surgical option for patients with significant bilateral disability. Unilateral STN DBS results in moderate improvement in all aspects of off-period parkinsonism and improves tremor as much as is typically reported with DBS of the ventral intermedius nucleus of the thalamus (Vim). For this reason, STN DBS may be a more appropriate choice than Vim DBS or thalamotomy for parkinsonian tremor. Some patients with highly asymmetric tremor-dominant PD might be appropriately treated with unilateral instead of bilateral STN DBS.
比较单侧丘脑底核（STN）深部脑刺激（DBS）与双侧STN DBS治疗晚期帕金森病（PD）的效果。
我们最初的10例连续的药物难治性运动波动和左旋多巴诱导的异动症患者接受了慢性双侧STN DBS治疗，在电极植入后6至18个月的药物洗脱状态下，对单侧和双侧STN DBS进行了标准化评估。
双侧STN DBS使帕金森病统一评分量表运动总分平均改善了54%，而单侧刺激仅使运动评分改善了23%。单侧STN DBS使姿势稳定性和步态改善了14%，其他轴性运动特征改善了19%，刺激对侧肢体的总体帕金森症状改善了46%，包括对侧震颤改善了86%。然而，双侧STN DBS在这些方面的改善更大，包括肢体功能，即双侧刺激比单侧刺激对侧STN时，一侧肢体的评分降低幅度更大。
双侧STN DBS比单侧STN DBS能更显著地改善帕金森症状；对于有明显双侧功能障碍的患者，双侧同时植入电极可能是最合适的手术选择。单侧STN DBS可使关期帕金森症状的各个方面得到中度改善，且震颤改善程度与丘脑腹中间核（Vim）DBS通常报道的程度相同。因此，对于帕金森震颤，STN DBS可能比Vim DBS或丘脑切开术更合适。一些震颤为主且高度不对称的PD患者可能适合用单侧而非双侧STN DBS治疗。
