Hamani Clement, Richter Erich, Schwalb Jason M, Lozano Andres M
Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
Neurosurgery. 2005 Jun;56(6):1313-21; discussion 1321-4. doi: 10.1227/01.neu.0000159714.28232.c4.
To evaluate the benefits and adverse effects of bilateral subthalamic nucleus stimulation in the treatment of Parkinson's disease (PD) by systematically reviewing the published literature.
A search of the PubMed database using the key words subthalamic, nucleus, and stimulation yielded 624 articles published between 1966 and December 2003. Only articles that included original, nonduplicated descriptions of patients with PD treated with bilateral subthalamic nucleus stimulation were selected for further analysis.
A total of 38 studies from 34 neurosurgical centers in 13 countries were identified for critical review. The outcomes for 471 patients with PD treated with bilateral subthalamic nucleus stimulation were assessed according to the Unified Parkinson's Disease Rating Scale in both on-medication and off-medication conditions. With stimulation, Unified Parkinson's Disease Rating Scale motor scores in the off-medication condition improved by 50% after 6 months, 56% after 12 months, 51% after 2 years, and 49% after 5 years compared with preoperative off-medication scores. At 12 months of subthalamic nucleus stimulation, the mean improvement in tremor was 81%, in rigidity was 63%, in bradykinesia was 52%, in gait was 64%, and in postural instability was 69% when compared with preoperative off-medication subscores. On-medication dyskinesias were reduced by 94%, as assessed 12 months after stimulation using the Unified Parkinson's Disease Rating Scale IV complications of therapy score. There was an overall 52% reduction in the l-dopa-equivalent dose intake after 12 months of stimulation. Most adverse effects were mild to moderate. There was a 1 to 2% incidence of severe adverse effects (death or permanent neurological deficits related to intracerebral hemorrhages). Nineteen percent of the patients had adverse effects related to stimulation that could be reversed by changing stimulation parameters. There was a 9% incidence of adverse effects related to the hardware (infections, lead and pulse generator problems).
Bilateral subthalamic nucleus stimulation is effective in the treatment of PD. Further refinements in patient selection and surgical technique may lessen the incidence of complications associated with this procedure.
通过系统回顾已发表的文献，评估双侧丘脑底核刺激治疗帕金森病（PD）的益处和不良反应。
在PubMed数据库中使用关键词“丘脑底核”“核”和“刺激”进行检索，共得到1966年至2003年12月发表的624篇文章。仅选择那些包含对接受双侧丘脑底核刺激治疗的PD患者进行原创、非重复描述的文章进行进一步分析。
共确定了来自13个国家34个神经外科中心的38项研究进行严格审查。根据统一帕金森病评定量表，在服药和未服药状态下评估了471例接受双侧丘脑底核刺激治疗的PD患者的治疗结果。与术前未服药评分相比，刺激后，未服药状态下统一帕金森病评定量表运动评分在6个月后改善了50%，12个月后改善了56%，2年后改善了51%，5年后改善了49%。在丘脑底核刺激12个月时，与术前未服药分项评分相比，震颤平均改善81%，强直改善63%，运动迟缓改善52%，步态改善64%，姿势不稳改善69%。使用统一帕金森病评定量表IV治疗并发症评分在刺激12个月后评估，服药状态下的异动症减少了94%。刺激12个月后，左旋多巴等效剂量摄入量总体减少了52%。大多数不良反应为轻至中度。严重不良反应（与脑出血相关的死亡或永久性神经功能缺损）的发生率为1%至2%。19%的患者有与刺激相关的不良反应，可通过改变刺激参数逆转。与硬件相关的不良反应（感染、电极和脉冲发生器问题）发生率为9%。
双侧丘脑底核刺激治疗PD有效。进一步优化患者选择和手术技术可能会降低与该手术相关的并发症发生率。
