Moreau C, Defebvre L, Destée A, Bleuse S, Clement F, Blatt J L, Krystkowiak P, Devos D
Clinique Neurologique, Hôpital R. Salengro, CHU, F-59037 Lille cedex, France.
Neurology. 2008 Jul 8;71(2):80-4. doi: 10.1212/01.wnl.0000303972.16279.46. Epub 2008 Apr 16.
Severe gait disturbances and freezing episodes (frequently resistant to optimal dopaminergic treatment) often appear in advanced Parkinson disease (PD). Even several years after initiation, high-frequency subthalamic nucleus deep brain stimulation (STN-DBS) is still very effective for controlling segmental symptoms. However, there are no long-term data on the management of gait disorders and freezing in STN-DBS.
To compare the effects of various STN-DBS parameters on freezing of gait and to determine whether such effects are more related to stimulation energy (usual voltages vs high voltages at 130 Hz) or frequency (130 Hz vs approximately half this frequency: 60 Hz).
We blindly assessed STN-DBS parameters in 13 PD patients reporting severe gait disorders. We compared the effects on gait of two different voltages (the patient's usual voltage [median 3 volts] and a high voltage [median 3.7 volts]) and two different frequencies (60 and 130 Hz, while maintaining the same total energy delivered) vs "off-stimulation" conditions.
The number of freezing episodes was significantly lower at the 60-Hz "high voltage/equivalent energy" and higher at the 130-Hz/high voltage than for "off stimulation." The slight improvement in the Unified Parkinson's Disease Rating Scale motor score observed (at 130 Hz) did not achieve statistical significance.
Our results prompt consideration of a new strategy for two-stage subthalamic nucleus deep brain stimulation (STN-DBS) frequency optimization, with stimulation at 130 Hz and the usual voltage during the initial years of STN-DBS and then at 60 Hz at a high voltage in Parkinson disease patients who develop severe gait disorders.
严重的步态障碍和冻结发作（通常对最佳多巴胺能治疗有抵抗性）常出现在晚期帕金森病（PD）中。即使在开始治疗数年之后，高频丘脑底核深部脑刺激（STN-DBS）对于控制节段性症状仍非常有效。然而，关于STN-DBS治疗步态障碍和冻结发作尚无长期数据。
比较不同STN-DBS参数对步态冻结的影响，并确定这些影响是否与刺激能量（通常电压与130Hz时的高电压）或频率（130Hz与大约该频率一半：60Hz）更相关。
我们对13例报告有严重步态障碍的PD患者的STN-DBS参数进行了盲法评估。我们比较了两种不同电压（患者的通常电压[中位数3伏]和高电压[中位数3.7伏]）以及两种不同频率（60和130Hz，同时保持输送的总能量相同）与“关刺激”条件对步态的影响。
60Hz“高电压/等效能量”时的冻结发作次数显著低于“关刺激”，而130Hz/高电压时则更高。观察到的统一帕金森病评定量表运动评分的轻微改善（在130Hz时）未达到统计学意义。
我们的结果促使考虑一种新的策略，用于两阶段丘脑底核深部脑刺激（STN-DBS）频率优化，即在STN-DBS的最初几年以130Hz和通常电压进行刺激，然后在出现严重步态障碍的帕金森病患者中以60Hz高电压进行刺激。
