Chen Chiung-Chu, Lee Shih-Tseng, Wu Tony, Chen Chi-Jen, Chen Ming-Chi, Lu Chin-Song
Movement Disorders Unit, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
Chang Gung Med J. 2003 May;26(5):344-51.
Subthalamic nucleus (STN) hyperactivity is a pathophysiological phenomenon of Parkinson's disease (PD). Inhibition of this hyperactivity by chronic deep brain stimulation (DBS) can possibly reset the aberrant function of the cortico-striato-thalamal circuit and improve the parkinsonian symptoms. DBS was introduced as a safe and alternative way of performing functional stereotaxic surgery for treating PD.
Seven advanced PD patients with complicated motor fluctuations and dyskinesia were enrolled in the study. A quadripolar electrode was bilaterally installed in the STN. Patients were evaluated before and 6 months after implantation using a battery of clinical assessments, including the motor score of the unified Parkinson's disease rating scale (UPDRS), modified Hoehn and Yahr (HY) staging, and the Schwab and England activities of daily living scale (SEADL). Preoperative baseline evaluations included both "off-medication" periods and "on-medication" periods, while postoperative evaluations included a cross-over of the above 2 periods with and without DBS.
The motor disability, HY staging, and SEADL all significantly improved in both the off- and on-medication periods 6 months after STN DBS. Compared to the baseline off-medication score, a significant improvement was found in the UPDRS motor and other subscores including tremors, rigidity, and bradykinesia. The SEADL score showed a great improvement of 205.6%. Ballism/chorea, mood changes, and blepharospasm may have been induced by DBS. Neither serious nor permanent side effects appeared.
Bilateral STN DBS improved the motor symptoms in advanced PD patients in both the off- and on-medication periods. They showed improvements not only in motor disabilities of tremors, rigidity, bradykinesia, and postural and gait instability, but also in levodopa-related dyskinesia and psychosis.
丘脑底核（STN）功能亢进是帕金森病（PD）的一种病理生理现象。通过慢性脑深部电刺激（DBS）抑制这种功能亢进可能会重置皮质-纹状体-丘脑回路的异常功能并改善帕金森症状。DBS被引入作为一种安全的、用于治疗PD的功能性立体定向手术替代方法。
七名患有复杂运动波动和异动症的晚期PD患者被纳入该研究。在双侧STN植入四极电极。在植入前及植入后6个月，使用一系列临床评估对患者进行评估，包括统一帕金森病评定量表（UPDRS）的运动评分、改良Hoehn和Yahr（HY）分期以及Schwab和England日常生活活动量表（SEADL）。术前基线评估包括“未服药”期和“服药”期，而术后评估包括上述两个时期在有和无DBS情况下的交叉评估。
STN DBS术后6个月，在未服药期和服药期，运动功能障碍、HY分期及SEADL均显著改善。与基线未服药评分相比，UPDRS运动及包括震颤、强直和运动迟缓在内的其他子评分有显著改善。SEADL评分有205.6%的显著提高。DBS可能诱发了投掷症/舞蹈症、情绪变化和眼睑痉挛。未出现严重或永久性副作用。
双侧STN DBS改善了晚期PD患者在未服药期和服药期的运动症状。患者不仅在震颤、强直、运动迟缓以及姿势和步态不稳等运动功能障碍方面有所改善，而且在左旋多巴相关异动症和精神症状方面也有改善。
