Rodrigues J P, Walters S E, Watson P, Stell R, Mastaglia F L
Movement Disorders Clinic, Australian Neuromuscular Research Institute, Perth, Western Australia, Australia.
J Clin Neurosci. 2007 Mar;14(3):208-15. doi: 10.1016/j.jocn.2005.11.023. Epub 2006 Dec 5.
Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has become an accepted therapeutic modality in selected Parkinson's disease (PD) patients with severe levodopa-induced dyskinesias (LID) and on-off motor fluctuations. In comparison to subthalamic nucleus DBS there is a paucity of data on GPi DBS outcomes. We present our experience with a group of 20 PD patients (9 unilateral, 11 bilateral) who underwent GPi stimulation. PD motor symptoms were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) part III scores and subscores, and dyskinesia using the Abnormal Involuntary Movement Scale (AIMS), UPDRS part IVa, and clinical global impression (CGI). At mean follow-up time of 7 months, bilateral stimulation reduced off-period motor scores by a mean of 46% and on-period motor scores by 18%. Unilateral stimulation reduced off-period motor scores by 18%. Dyskinesia severity was reduced by 76%, which was maintained after a mean follow-up time of 35 months. Antiparkinsonian medication dosage was unchanged. No major adverse effects were seen. Unilateral and bilateral GPi DBS provides lasting benefit in PD patients with severe LID. Beneficial effects on off-period motor symptoms are greater with bilateral stimulation; however, with maintenance of dopaminergic medication, unilateral procedures can also provide important and sustained benefits.
对内侧苍白球（GPi）进行深部脑刺激（DBS）已成为部分患有严重左旋多巴诱导性异动症（LID）和开关样运动波动的帕金森病（PD）患者可接受的治疗方式。与丘脑底核DBS相比，关于GPi DBS疗效的数据较少。我们介绍了一组20例接受GPi刺激的PD患者（9例单侧，11例双侧）的治疗经验。使用统一帕金森病评定量表（UPDRS）第三部分评分及子评分评估PD运动症状，使用异常不自主运动量表（AIMS）、UPDRS第四部分a项及临床整体印象（CGI）评估异动症。在平均7个月的随访时间里，双侧刺激使关期运动评分平均降低46%，开期运动评分降低18%。单侧刺激使关期运动评分降低18%。异动症严重程度降低了76%，在平均35个月的随访时间后仍保持这一效果。抗帕金森病药物剂量未改变。未观察到重大不良反应。单侧和双侧GPi DBS对患有严重LID的PD患者具有持久益处。双侧刺激对关期运动症状的有益作用更大；然而，在维持多巴胺能药物治疗的情况下，单侧手术也能提供重要且持续的益处。
