Tabbal Samer D, Ushe Mwiza, Mink Jonathan W, Revilla Fredy J, Wernle Angie R, Hong Minna, Karimi Morvarid, Perlmutter Joel S
Department of Neurology, Washington University in St. Louis, 4525 Scott Avenue, St. Louis, MO 63130, USA.
Exp Neurol. 2008 May;211(1):234-42. doi: 10.1016/j.expneurol.2008.01.024. Epub 2008 Feb 14.
Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor function in Parkinson disease (PD). However, little is known about the quantitative effects on motor behavior of unilateral STN DBS.
In 52 PD subjects with STN DBS, we quantified in a double-blinded manner rigidity (n=42), bradykinesia (n=38), and gait speed (n=45). Subjects were tested in four DBS conditions: both on, left on, right on and both off. A force transducer was used to measure rigidity across the elbow, and gyroscopes were used to measure angular velocity of hand rotations for bradykinesia. About half of the subjects were rated using the Unified Parkinson Disease Rating Scale (part III) motor scores for arm rigidity and repetitive hand rotation simultaneously during the kinematic measurements. Subjects were timed walking 25 feet.
All subjects had significant improvement with bilateral STN DBS. Contralateral, ipsilateral and bilateral stimulation significantly reduced rigidity and bradykinesia. Bilateral stimulation improved rigidity more than unilateral stimulation of either side, but there was no significant difference between ipsilateral and contralateral stimulation. Although bilateral stimulation also increased hand rotation velocity more than unilateral stimulation of either side, contralateral stimulation increased hand rotation significantly more than ipsilateral stimulation. All stimulation conditions improved walking time but bilateral stimulation provided the greatest improvement.
Unilateral STN DBS decreased rigidity and bradykinesia contralaterally as well ipsilaterally. As expected, bilateral DBS improved gait more than unilateral DBS.
双侧丘脑底核（STN）深部脑刺激（DBS）可改善帕金森病（PD）的运动功能。然而，关于单侧STN DBS对运动行为的定量影响知之甚少。
在52例接受STN DBS治疗的PD患者中，我们以双盲方式对肌张力增高（n = 42）、运动迟缓（n = 38）和步态速度（n = 45）进行了量化。对患者在四种DBS状态下进行测试：双侧开启、左侧开启、右侧开启和双侧关闭。使用力传感器测量肘部的肌张力，使用陀螺仪测量手部旋转的角速度以评估运动迟缓。在运动学测量过程中，约一半的患者同时使用统一帕金森病评定量表（第三部分）对上肢肌张力和手部重复旋转进行运动评分。记录患者步行25英尺的时间。
所有患者在双侧STN DBS治疗后均有显著改善。对侧、同侧和双侧刺激均显著降低了肌张力和运动迟缓。双侧刺激比任一侧的单侧刺激更能改善肌张力，但同侧和对侧刺激之间无显著差异。虽然双侧刺激也比任一侧的单侧刺激更能提高手部旋转速度，但对侧刺激比同侧刺激更能显著提高手部旋转速度。所有刺激状态均改善了步行时间，但双侧刺激改善最为明显。
单侧STN DBS可降低同侧和对侧的肌张力及运动迟缓。正如预期的那样，双侧DBS比单侧DBS更能改善步态。
