Patel N K, Plaha P, O'Sullivan K, McCarter R, Heywood P, Gill S S
Institute of Neurosciences, Frenchay Hospital, Bristol, UK.
J Neurol Neurosurg Psychiatry. 2003 Dec;74(12):1631-7. doi: 10.1136/jnnp.74.12.1631.
Bilateral chronic high frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) has emerged as an appropriate therapy for patients with advanced Parkinson's disease refractory to medical therapy. Advances in neuroimaging and neurophysiology have led to the development of varied targeting methods for the delivery of this treatment. Intraoperative neurophysiological and clinical monitoring is regarded by many to be mandatory for accurate STN localisation. We have examined efficacy of bilateral STN stimulation using a predominantly magnetic resonance imaging (MRI)-directed technique.
DBS leads were stereotactically implanted into the STN using an MRI directed method, with intraoperative macrostimulation used purely for adjustment. The effects of DBS were evaluated in 16 patients followed up to 12 months, and compared with baseline assessments. Assessments were performed in both off and on medication states, and were based on the Unified Parkinson's Disease Rating Scale (UPDRS) and timed motor tests. Functional status outcomes were examined using the PDQ-39 quality of life questionnaire. A battery of psychometric tests was used to assess cognition.
After 12 months, stimulation in the off medication state resulted in significant improvements in Activities of Daily Living and Motor scores (UPDRS parts II and III) by 62% and 61% respectively. Timed motor tests were significantly improved in the off medication state. Motor scores (UPDRS part III) were significantly improved by 40% in the on medication state. Dyskinesias and off duration were significantly reduced and the mean dose of L-dopa equivalents was reduced by half. Psychometric test scores were mostly unchanged or improved. Adverse events were few.
An MRI directed targeting method for implantation of DBS leads into the STN can be used safely and effectively, and results are comparable with studies using intraoperative microelectrode neurophysiological targeting. In addition, our method was associated with an efficient use of operating time, and without the necessary costs of microelectrode recording.
双侧丘脑底核（STN）慢性高频深部脑刺激（DBS）已成为药物治疗难治的晚期帕金森病患者的一种合适治疗方法。神经影像学和神经生理学的进展促使了多种用于这种治疗的靶点定位方法的发展。许多人认为术中神经生理学和临床监测对于准确的STN定位是必不可少的。我们研究了主要使用磁共振成像（MRI）引导技术进行双侧STN刺激的疗效。
采用MRI引导方法将DBS电极立体定向植入STN，术中宏观刺激仅用于调整。对16例随访12个月的患者评估DBS的效果，并与基线评估进行比较。在服药和未服药状态下均进行评估，评估基于统一帕金森病评定量表（UPDRS）和定时运动测试。使用PDQ-39生活质量问卷检查功能状态结果。使用一系列心理测量测试来评估认知。
12个月后，未服药状态下的刺激使日常生活活动和运动评分（UPDRS第二部分和第三部分）分别显著提高62%和61%。未服药状态下定时运动测试显著改善。服药状态下运动评分（UPDRS第三部分）显著提高40%。异动症和关期时间显著减少，左旋多巴等效剂量平均减少一半。心理测量测试分数大多未变或有所改善。不良事件很少。
将DBS电极植入STN的MRI引导靶点定位方法可以安全有效地使用，其结果与使用术中微电极神经生理学靶点定位的研究相当。此外，我们的方法有效利用了手术时间，且无需微电极记录的成本。
