Durif F, Lemaire J J, Debilly B, Dordain G
Fédération de Neurologie, Hôpital Gabriel Montpied, Clermont-Ferrand, France.
J Neurol Neurosurg Psychiatry. 1999 Sep;67(3):315-22. doi: 10.1136/jnnp.67.3.315.
To evaluate the effects of acute and chronic stimulation in the anteromedial part of the globus pallidus internus (GPi) on the symptoms of patients with Parkinson's disease.
Six patients with severe Parkinson's disease (Hoehn and Yahr stage 4-5 in "off" drug condition) with motor fluctuations and levodopa induced dyskinesia (LID) were operated on. Chronic electrodes were implanted in the anteromedial GPi bilaterally in five patients and unilaterally in one patient. The effect of stimulation via the four contacts for each electrode (n=11) was assessed postoperatively on the contralateral parkinsonian signs in the off condition and on the contralateral and ipsilateral LID in the "on" condition. The core assessement program for intracerebral transplantation protocol was performed before surgery and then 1, 3, and 6 months after surgery in on and off conditions and in on and off stimulation conditions.
Stimulation performed postoperatively showed a significant improvement (p<0.05) by 47% (contralateral rigidity) and 32% (contralateral bradykinesia) when stimulation was applied through the distal contact. Levodopa induced dyskinesias were improved by 95% (contralateral LID) and by 66% (ipsilateral LID) when stimulation was applied through the distal contact. Six months after the surgery, GPi stimulation in the off condition led to a mean improvement in the motor score of UPDRS by 36%. The mean daily duration in the off state decreased by 52% (p<0.05). The mean duration of LIDs decreased by 68% (p<0.05) and their severity by 53% (p<0.05).
Chronic stimulation in the anteromedial GPi shows that this is a safe and effective treatment for advanced Parkinson's disease with benefit sustained for at least 6 months.
评估内侧苍白球腹内侧部（GPi）急性和慢性刺激对帕金森病患者症状的影响。
对6例患有严重帕金森病（在“关”药状态下Hoehn - Yahr分期为4 - 5期）且存在运动波动和左旋多巴诱发异动症（LID）的患者进行手术。5例患者双侧内侧GPi植入慢性电极，1例患者单侧植入。术后通过每个电极的4个触点（n = 11）进行刺激，评估其对“关”状态下对侧帕金森体征以及“开”状态下对侧和同侧LID的影响。在手术前以及术后1、3和6个月，分别在“开”和“关”状态以及“开”和“关”刺激状态下执行脑内移植方案的核心评估程序。
术后刺激显示，当通过远端触点进行刺激时，对侧强直改善47%（p < 0.05），对侧运动迟缓改善32%（p < 0.05）。当通过远端触点进行刺激时，左旋多巴诱发的异动症对侧LID改善95%，同侧LID改善66%。术后6个月，“关”状态下GPi刺激使统一帕金森病评定量表（UPDRS）运动评分平均改善36%。“关”状态的平均每日时长减少52%（p < 0.05）。LID的平均时长减少68%（p < 0.05），其严重程度降低53%（p < 0.05）。
内侧GPi慢性刺激表明，这是一种治疗晚期帕金森病的安全有效方法，且益处可持续至少6个月。
