Benabid A L, Benazzouz A, Limousin P, Koudsie A, Krack P, Piallat B, Pollak P
Department of Clinical and Biological Neurosciences, INSERM Preclinical Neurobiology U-318, Joseph Fourier University of Grenoble, Hôpital A. Michallon, France.
Ann Neurol. 2000 Apr;47(4 Suppl 1):S189-92.
Severe dyskinesias or ballism can occur following hemorrhagic events in the subthalamic nucleus (STN), and it has recently been established that the STN plays a major role in the pathophysiology of the motor dysfunction of Parkinson's disease (PD) and that STN inhibition improves parkinsonian dysfunction. Deep brain stimulation of the STN in PD patients is therefore currently being evaluated as a therapy. High-frequency stimulation of the STN in PD patients can induce intense dyskinesias that are similar to those induced by levodopa. These may occur with a variable latency and resemble all types of levodopa-induced dyskinesias (LIDs). They can be decreased by reducing the levodopa dosage, which is permitted by the antiparkinsonian effect of stimulating the STN. STN stimulation has been shown to improve all types of LIDs, with the most dramatic effect being that on off-period dystonia. The improvement in LIDs may relate to the decrease in drug dosage, while the off-period dystonia is likely improved by the simultaneous administration of levodopa and STN stimulation. It is thought that the STN is an important node in a network, which can produce dyskinesias when disturbed by a lesion, and is particularly sensitive for the induction of these abnormal movements.
丘脑底核（STN）出血事件后可出现严重的运动障碍或舞蹈症，最近已经确定STN在帕金森病（PD）运动功能障碍的病理生理学中起主要作用，并且抑制STN可改善帕金森病功能障碍。因此，目前正在评估对PD患者进行丘脑底核的深部脑刺激作为一种治疗方法。对PD患者的丘脑底核进行高频刺激可诱发强烈的运动障碍，类似于左旋多巴诱发的运动障碍。这些运动障碍可能在不同的潜伏期出现，类似于所有类型的左旋多巴诱发的运动障碍（LIDs）。通过减少左旋多巴剂量可减轻这些症状，而刺激STN的抗帕金森病作用允许这样做。已证明刺激STN可改善所有类型的LIDs，其中对关期肌张力障碍的效果最为显著。LIDs的改善可能与药物剂量的减少有关，而关期肌张力障碍可能通过同时给予左旋多巴和刺激STN而得到改善。据认为，丘脑底核是一个网络中的重要节点，当受到损伤干扰时会产生运动障碍，并且对诱发这些异常运动特别敏感。
