Loher Thomas J, Burgunder Jean-Marc, Pohle Thomas, Weber Sabine, Sommerhalder Regine, Krauss Joachim K
Department of Neurology, Inselspital, University of Berne, Switzerland.
J Neurosurg. 2002 May;96(5):844-53. doi: 10.3171/jns.2002.96.5.0844.
The goal of this study was to investigate the efficacy of long-term deep brain stimulation (DBS) of the posteroventral lateral globus pallidus internus (GPi) accomplished using a single-contact monopolar electrode in patients with advanced Parkinson disease (PD).
Sixteen patients suffering from severe PD and levodopa-induced side effects such as dyskinesias and on-off fluctuations were enrolled in a prospective study protocol. There were six women and 10 men and their mean age at surgery was 65 years. All patients underwent implantation of a monopolar electrode in the posteroventral lateral GPi. Initially, nine patients received unilateral stimulation. Three of these patients underwent contralateral surgery at a later time. Ten patients received bilateral stimulation (contemporaneous bilateral surgery was performed in seven patients and staged bilateral surgery in the three patients who had received unilateral stimulation initially). Formal assessments were performed during both off-medication and on-medication (levodopa) periods preoperatively, and at 3 and 12 months postoperatively. There were no serious complications related to surgery or to DBS. Two transient adverse events occurred: in one patient a small pallidal hematoma developed, resulting in a prolonged micropallidotomy effect, and in another patient a subcutaneous hemorrhage occurred at the site of the pacemaker. In patients who received unilateral DBS, the Unified Parkinson's Disease Rating Scale activities of daily living (ADL) score during the off-levodopa period decreased from 30.8 at baseline to 20.4 at 3 months (34% improvement) and 20.6 at 12 months (33% improvement) postoperatively. The motor score during the off period improved from 57.2 at baseline to 35.2 at 3 months (38% improvement) and 35.3 at 12 months (38% improvement) postoperatively. Bilateral DBS resulted in a reduction in the ADL score during the off period from 34.9 at baseline to 22.3 at 3 months (36% improvement) and 22.9 at 12 months (34% improvement). The motor score for the off period changed from 63.4 at baseline to 40.3 at 3 months (36% improvement) and 37.5 at 12 months (41% improvement). In addition, there were significant improvements in patients' symptoms during the on period and in on-off motor fluctuations.
Pallidal DBS accomplished using a monopolar electrode is a safe and effective procedure for treatment of advanced PD. Compared with pallidotomy, the advantages of pallidal DBS lie in its reversibility and the option to perform bilateral surgery in one session. Comparative studies in which DBS is applied to other targets are needed.
本研究旨在探讨使用单触点单极电极对晚期帕金森病（PD）患者进行苍白球内侧部腹后外侧（GPi）长期深部脑刺激（DBS）的疗效。
16例患有严重PD且有左旋多巴诱发的异动症和开关现象等副作用的患者纳入前瞻性研究方案。其中女性6例，男性10例，手术时的平均年龄为65岁。所有患者均在GPi腹后外侧植入单极电极。最初，9例患者接受单侧刺激。其中3例患者随后接受了对侧手术。10例患者接受双侧刺激（7例患者同期进行双侧手术，3例最初接受单侧刺激的患者进行分期双侧手术）。在术前的非用药期和用药（左旋多巴）期以及术后3个月和12个月进行了正式评估。没有与手术或DBS相关的严重并发症。发生了2例短暂不良事件：1例患者出现小的苍白球血肿，导致微苍白球切开术效果延长，另1例患者在起搏器部位发生皮下出血。接受单侧DBS的患者，在停用左旋多巴期间，统一帕金森病评定量表日常生活活动（ADL）评分从基线时的30.8降至术后3个月时的20.4（改善34%）和12个月时的20.6（改善33%）。非运动期运动评分从基线时的57.2改善至术后3个月时的35.2（改善38%）和12个月时的35.3（改善38%）。双侧DBS导致非运动期ADL评分从基线时的34.9降至术后3个月时的22.3（改善36%）和12个月时的22.9（改善34%）。非运动期运动评分从基线时的63.4变为术后3个月时的40.3（改善36%）和12个月时的37.5（改善41%）。此外，患者在运动期的症状以及开关运动波动也有显著改善。
使用单极电极进行苍白球DBS是治疗晚期PD的一种安全有效的方法。与苍白球切开术相比，苍白球DBS的优势在于其可逆性以及能够在一次手术中进行双侧手术。需要进行将DBS应用于其他靶点的对比研究。
