Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
Eur J Neurol. 2010 May;17(5):746-53. doi: 10.1111/j.1468-1331.2010.02962.x. Epub 2010 Mar 22.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson's disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact.
The active contact was visualized on peri-operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS-III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN.
Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS-III significantly more than ventral STN DBS (P = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (P = 0.03 and P = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation.
Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. Possible different effects of stimulation inside the nucleus underline the need for exact knowledge of the active stimulation site position to target the most effective area.
深部脑刺激（DBS）于丘脑底核（STN）可有效缓解帕金森病（PD）症状（震颤、僵直和运动迟缓），并可能改善与疾病相关的步态和姿势障碍。然而，步态改善并不总是像临床结果那样可预测。这可能与步态障碍的类型或 DBS 有效接触的定位有关。
在 22 例特发性 PD 患者中，连续行双侧 STN-DBS 治疗，在围手术期磁共振成像上对主动接触进行可视化。刺激部位分为 STN 的背/腹侧或其内侧/外侧和前/后或其内侧/外侧。将定位与临床结果（UPDRS-III）的相对改善进行比较。在 10 例患者中，进行了定量步态分析，并将步态表现的改善与 STN 中的刺激部位进行比较。
44 个主动接触中，77%位于核内，23%位于核内内侧。与 STN 腹侧刺激相比，STN 背侧的刺激使 UPDRS-III 显著改善更多（P=0.02）。然而，在背侧 STN 中，前侧和后侧刺激之间没有差异。与腹侧刺激相比，背侧刺激使步速和步长显著改善更多（P=0.03 和 P=0.02）。与腹侧刺激相比，背侧刺激也使步态平衡得到了更多改善。
STN 背侧的 DBS 优于 STN 腹侧刺激。刺激核内的可能存在不同影响，这强调了需要准确了解主动刺激部位的位置，以针对最有效的区域。
