苍白球毁损术成功后丘脑底核深部脑刺激治疗帕金森病：临床与电生理观察

Subthalamic nucleus deep brain stimulation for parkinson's disease after successful pallidotomy: clinical and electrophysiological observations.

作者信息

Kleiner-Fisman Galit, Fisman David N, Zamir Orit, Dostrovsky Jonathan O, Sime Elspeth, Saint-Cyr Jean A, Lozano Andres M, Lang Anthony E

机构信息

Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

出版信息

Mov Disord. 2004 Oct;19(10):1209-14. doi: 10.1002/mds.20151.

DOI:10.1002/mds.20151

PMID:15390008

Abstract

Unilateral pallidotomy is an effective treatment for contralateral parkinsonism and dyskinesia, yet symptoms progress in many patients. Little is known about whether such patients obtain a useful response to subsequent bilateral subthalamic nucleus deep brain stimulation (STN DBS). Changes in Unified Parkinson's Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores, medication requirements, and dyskinesias were measured. Clinical outcomes were compared to patients with de novo STN DBS. Neuronal recordings were performed. STN DBS resulted in a significant reduction in UPDRS Motor scores (42.1%; 95% confidence interval [CI], 26.9-57.4; P = 0.03), comparable with de novo STN DBS surgery (41%; 95% CI, 26-46%; P < 0.001). There was also less change in dyskinesia duration and disability scores (P = 0.017, 0.005). There were no side-to-side differences clinically or in the STN neuronal firing rates and patterns. Bilateral STN DBS is safe and efficacious in improving motor symptoms in patients with prior pallidotomy.

摘要

单侧苍白球切开术是治疗对侧帕金森病和异动症的有效方法，但许多患者的症状仍会进展。对于此类患者是否能从后续的双侧丘脑底核深部脑刺激（STN DBS）中获得有效反应，目前知之甚少。我们测量了统一帕金森病评定量表（UPDRS）运动和日常生活活动（ADL）评分、药物需求以及异动症的变化。将临床结果与初发STN DBS患者进行比较。进行了神经元记录。STN DBS使UPDRS运动评分显著降低（42.1%；95%置信区间[CI]，26.9 - 57.4；P = 0.03），与初发STN DBS手术相当（41%；95% CI，26 - 46%；P < 0.001）。异动症持续时间和残疾评分的变化也较小（P = 0.017，0.005）。在临床或STN神经元放电率及模式方面，两侧没有差异。双侧STN DBS对于曾接受苍白球切开术的患者改善运动症状是安全有效的。