帕金森病双侧苍白球深部脑刺激术后的双侧丘脑底核深部脑刺激
Bilateral subthalamic deep brain stimulation after bilateral pallidal deep brain stimulation for Parkinson's disease.
作者信息
Deogaonkar Milind, Monsalve Guillermo A, Scott Jenera, Ahmed Anwar, Rezai Ali
机构信息
Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
出版信息
Stereotact Funct Neurosurg. 2011;89(2):123-7. doi: 10.1159/000323375. Epub 2011 Feb 17.
BACKGROUND/OBJECTIVE: Globus pallidus internus (GPi) and subthalamic nucleus (STN) have successfully been targeted independently for deep brain stimulator (DBS) placement in medically intractable Parkinson's disease (PD). Bilateral implantation of STN DBS in a patient with preexisting, functioning GPi DBS to specifically treat motor fluctuations is, to our knowledge, yet unreported.
CLINICAL PRESENTATION
We present a case of PD who had well-placed bilateral GPi DBS that controlled dyskinesia effectively and improved the motor symptoms like rigidity and akinesia. It did not improve her motor fluctuations and failed to reduce her medications.
METHODS
We implanted bilateral STN DBS, which improved her 'on' time, reduced her medications and improved her motor scores.
RESULTS/CONCLUSION: In this report we discuss the rationale, technical issues, programming nuances and outcome in a patient with preexisting bilateral GPi DBS who was implanted with bilateral STN DBS.
背景/目的：苍白球内侧部（GPi）和丘脑底核（STN）已成功地分别作为靶点用于药物难治性帕金森病（PD）的脑深部电刺激器（DBS）植入。据我们所知，尚未有关于在已有功能正常的GPi DBS的患者中双侧植入STN DBS以专门治疗运动波动的报道。
临床表现
我们报告1例PD患者，其双侧GPi DBS植入位置良好，有效控制了异动症，并改善了如僵硬和运动不能等运动症状。但它并未改善患者的运动波动，也未能减少其药物用量。
方法
我们为该患者植入了双侧STN DBS，这改善了她的“开”期时间，减少了她的药物用量，并提高了她的运动评分。
结果/结论：在本报告中，我们讨论了1例已有双侧GPi DBS的患者植入双侧STN DBS的理论依据、技术问题、程控细节及结果。
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