Yokoyama Tetsuo, Ando Naoto, Sugiyama Kenji, Akamine Soichi, Namba Hiroki
Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Stereotact Funct Neurosurg. 2006;84(4):170-5. doi: 10.1159/000094956. Epub 2006 Aug 10.
To determine the relationship of the stimulation site in the subthalamic region to the clinical effects on parkinsonian symptoms, the monopolar stimulation of 4 electrode contacts and the resulting effects on parkinsonian symptoms were evaluated.
Seventeen consecutive patients (3 males and 14 females) were enrolled in the study. The patients were evaluated while in a nonmedicated state, and 10-20 min after switching on the pulse generator the effects of stimulation were assessed using separate-subset Unified Parkinson's Disease Rating Scale scores.
The relationship between the site stimulated and the percent improvement was analyzed using polynomial regression. Rigidity (p = 0.0004, R2 = 0.15), akinesia (p = 0.02, R2 = 0.07) and total score (p = 0.009, R2 = 0.089) well fit to second-order polynomial regression and showed the greatest improvement after stimulation at 0-1 mm below the horizontal anterior-posterior commissure (AC-PC) plane. Tremor (p = 0.24, R2 = 0.18) and gait (p = 0.36, R2 = 0.001) had a weak relation to the site stimulated, but stimulation at the sites 0-1 mm below the AC-PC plane also produced greater improvement than stimulation at more ventral or dorsal sites. The percent improvement of the posture (p = 0.92, R2 = 0.002) had no relation to the site stimulated. The dorsal border of the subthalamic nucleus was located 0.6 +/- 1.2 mm (n = 27) below the AC-PC plane and the most effective electrode contact 1.2 +/- 1.3 mm (n = 27) below it.
Stimulation around the dorsal border of the subthalamic nucleus, close to the AC-PC plane, produces greater improvement of parkinsonian symptoms than stimulation at more ventral or dorsal sites.
为确定丘脑底区域的刺激部位与帕金森症状临床疗效之间的关系，对4个电极触点的单极刺激及其对帕金森症状的影响进行了评估。
连续纳入17例患者（3例男性，14例女性）。在患者未用药状态下进行评估，并在开启脉冲发生器10 - 20分钟后，使用独立子集统一帕金森病评定量表评分评估刺激效果。
采用多项式回归分析刺激部位与改善百分比之间的关系。强直（p = 0.0004，R² = 0.15）、运动不能（p = 0.02，R² = 0.07）和总分（p = 0.009，R² = 0.089）与二阶多项式回归拟合良好，在前后连合（AC - PC）平面下方0 - 1毫米处刺激后改善最为明显。震颤（p = 0.24，R² = 0.18）和步态（p = 0.36，R² = （此处原文可能有误，推测应为0.01，根据上下文逻辑）0.001）与刺激部位的关系较弱，但在AC - PC平面下方0 - 1毫米处的刺激也比在更腹侧或背侧部位的刺激产生更大改善。姿势改善百分比（p = 0.92，R² = 0.002）与刺激部位无关。丘脑底核的背侧边界位于AC - PC平面下方0.6±1.2毫米（n = 27）处，最有效的电极触点位于其下方1.2±1.3毫米（n = 27）处。
在靠近AC - PC平面的丘脑底核背侧边界周围进行刺激，比在更腹侧或背侧部位进行刺激能更有效地改善帕金森症状。
