Carrillo-Ruiz J D, Velasco F, Jiménez F, Velasco A L, Velasco M, Castro G
Service of Stereotactic and Functional Neurosurgery and Radiosurgery of Mexico General Hospital, Mexico City, Mexico.
Acta Neurochir Suppl. 2007;97(Pt 2):185-90. doi: 10.1007/978-3-211-33081-4_20.
In patients with Parkinson's disease (PD), tetrapolar electrodes were implanted in the prelemniscal radiations (RAPRL) to treat tremor, rigidity and bradykinesia. Fifteen patients were implanted unilaterally and five patients bilaterally and followed-up for one year. The selection criteria included the presence of unilateral pronounced tremor and rigidity in patients implanted unilaterally or bilateral symptoms including severe bradykinesia in patients implanted bilaterally. In the operating room, the tremor decreased significantly or was abolished following the insertion of the electrode in the RAPRL. This effect was temporary and subsided when the stimulation was off. However, when the stimulator was turned on, the severity of the symptoms and signs decreased significantly. The post-implantation MRI confirmed that the electrode contacts used for stimulation were inserted in RAPRL, a group of fibers located between the red nucleus and subthalamic nucleus, above the substantia nigra, medially to the zona incerta and below the thalamus. The patients were evaluated using the UPDRS part III, before implantation and every 3 months during the first year. Global scores decreased significantly. The pre- and postoperative median values (range in round brackets) were as follows: tremor improved from 3 (2-16) to 1 (2-3) (p<0.001); rigidity was either abolished or decreased markedly from 2 (1-16) to 0 (0-4) (p< 0.001); bradykinesia improved from 2 (0-4) to 1 (0-2) (p<0.001). We conclude that RAPRL, an area anatomically different from STN, is a good target for electrical stimulation in order to treat effectively all the main symptoms of PD.
在帕金森病（PD）患者中，将四极电极植入丘脑前辐射（RAPRL）以治疗震颤、强直和运动迟缓。15例患者单侧植入，5例患者双侧植入，并随访一年。选择标准包括单侧植入患者存在单侧明显震颤和强直，或双侧植入患者存在包括严重运动迟缓在内的双侧症状。在手术室中，将电极插入RAPRL后震颤明显减轻或消失。这种效果是暂时的，刺激关闭时就会消退。然而，当刺激器打开时，症状和体征的严重程度明显降低。植入后MRI证实用于刺激的电极触点插入了RAPRL，RAPRL是一组位于红核和丘脑底核之间、黑质上方、未定带内侧和丘脑下方的纤维。在植入前以及第一年中每3个月使用统一帕金森病评定量表（UPDRS）第三部分对患者进行评估。总体评分显著降低。术前和术后的中位数（括号内为范围）如下：震颤从3（2 - 16）改善至1（2 - 3）（p<0.001）；强直要么消失，要么从2（1 - 16）显著降至0（0 - 4）（p<0.001）；运动迟缓从2（0 - 4）改善至1（0 - 2）（p<0.001）。我们得出结论，RAPRL是一个在解剖学上与丘脑底核不同的区域，是电刺激治疗PD所有主要症状的良好靶点。
