Thobois S, Mertens P, Guenot M, Hermier M, Mollion H, Bouvard M, Chazot G, Broussolle E, Sindou M
Service de Neurologie D, Hopital Neurologique Pierre Wertheimer, 59 Bd Pinel, 69003 Lyon, France.
J Neurol. 2002 May;249(5):529-34. doi: 10.1007/s004150200059.
The aim of the present study was to assess the efficacy and safety of chronic subthalamic nucleus deep-brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). 18 consecutive severely affected PD patients were included (mean age, SD: 56.9+/-6 years; mean disease duration: 13.5+/-4.4 years). All the patients were evaluated clinically before and 6 months after the surgical procedure using the Unified Parkinson's Disease Rating Scale (UPDRS). Additionally, a 12 months follow-up was available in 14 patients. The target coordinates were determined by ventriculography under stereotactic conditions, followed by electrophysiology and intraoperative stimulation. After surgery, continuous monopolar stimulation was applied bilaterally in 17 patients at 2.9+/-0.4 V through 1 (n = 31) or 2 contacts (n = 3). One patient had bilateral bipolar stimulation. The mean frequency of stimulation was 140+/-16 Hz and pulse width 68+/-13 micros. Off medication, the UPDRS part III score (max = 108) was reduced by 55 % during on stimulation (score before surgery: 44.9+/-13.4 vs at 6 months: 20.2+/-10; p < 0.001). In the on medication state, no difference was noted between the preoperative and the postoperative off stimulation conditions (scores were respectively: 17.9+/-9.2 and 23+/-12.6). The severity of motor fluctuations and dyskinesias assessed by UPDRS IV was reduced by 76 % at 6 months (scores were respectively: 10.3+/-3 and 2.5+/-3; p < 0.001). Off medication, the UPDRS II or ADL score was reduced by 52.8 % during on stimulation (26.9+/-6.5 preop versus 12.7+/-7 at 6 months). The daily dose of antiparkinsonian treatment was diminished by 65.5 % (levodopa equivalent dose -- mg/D -- was 1045 +/- 435 before surgery and 360 +/- 377 at 6 months; p < 0.01). These results remained stable at 12 months for the 14 patients studied. Side effects comprised lower limb phlebitis (n = 2), pulmonary embolism (n = 1), depression (n = 6), dysarthria and freezing (n = 1), sialorrhea and drooling (n = 1), postural imbalance (n = 1), transient paresthesias and dyskinesias. This study confirms the great value of subthalamic nucleus stimulation in the treatment of intractable PD. Some adverse events such as depression may be taken into account in the inclusion criteria and also in the post-operative outcome.
本研究的目的是评估慢性丘脑底核深部脑刺激（STN-DBS）治疗帕金森病（PD）患者的疗效和安全性。纳入了18例连续的重度PD患者（平均年龄，标准差：56.9±6岁；平均病程：13.5±4.4年）。所有患者在手术前和手术后6个月使用统一帕金森病评定量表（UPDRS）进行临床评估。此外，14例患者进行了12个月的随访。通过立体定向条件下的脑室造影确定靶点坐标，随后进行电生理学和术中刺激。术后，17例患者通过1个（n = 31）或2个触点（n = 3）以2.9±0.4 V双侧进行连续单极刺激。1例患者进行双侧双极刺激。平均刺激频率为140±16 Hz，脉冲宽度为68±13微秒。在未服药状态下，刺激开启时UPDRS第三部分评分（最大值 = 百零八）降低了55%（手术前评分：44.9±13.4 vs 6个月时：20.2±10；p < 0.001）。在服药状态下，术前和术后刺激关闭条件之间未观察到差异（评分分别为：17.9±9.2和23±12.6）。通过UPDRS第四部分评估的运动波动和异动症严重程度在6个月时降低了76%（评分分别为：10.3±3和2.5±3；p < 0.001）。在未服药状态下，刺激开启时UPDRS第二部分或日常生活活动能力评分降低了52.8%（术前26.9±6.5 vs 6个月时12.7±7）。抗帕金森病治疗的每日剂量减少了65.5%（左旋多巴等效剂量——mg/D——手术前为1045±435，6个月时为360±377；p < 0.01）。对于所研究的14例患者，这些结果在12个月时保持稳定。副作用包括下肢静脉炎（n = 2）、肺栓塞（n = 1）、抑郁（n = 6）、构音障碍和冻结（n = 1）、流涎和流口水（n = 1）、姿势失衡（n = 1）、短暂性感觉异常和异动症。本研究证实了丘脑底核刺激在治疗难治性PD中的巨大价值。在纳入标准以及术后结果中可能需要考虑一些不良事件，如抑郁。
