Division of Neurosurgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Neurosurgery. 2012 Mar;70(1 Suppl Operative):125-30; discussion 130-1. doi: 10.1227/NEU.0b013e318232fdac.
Psychiatric and neuropsychological side effects of subthalamic nucleus (STN) stimulation have been increasingly recognized. Most programming regimens focus on contacts 0 and 1, whereas contact 3, which often is located near or in the zona incerta (ZI), is usually not used. The question of whether ZI stimulation may limit limbic effects has not been answered.
To examine the effects of short-term stimulation near or in the ZI (contact 3) compared with stimulation of the STN using standard trajectories and targeting as measured by limbic and motor functions.
Motor and limbic functions of 11 patients with STN DBS were assessed with the Unified Parkinson Disease Rating Scale-3, structured gait video analysis, Visual Analog Scale mood scales, task testing of impulsivity, and facial recognition under routine STN programming and under stimulation in or near the ZI. Postoperative magnetic resonance imaging confirmed the location of contact 3 near or in the ZI.
Data analysis with repeated-measures analysis of variance revealed that motor scores remained stable with both stimulation settings, with specific improvements in finger taps (P = .02) and rapid alternating movements (P = .03) in ZI stimulation. Stimulation near or in the ZI led to a decrease in self- reported anxiety and depression (P = .03 for both) and an improvement in fear recognition (P = .02).
We provide preliminary evidence that stimulation in or near the ZI results in maintained motor function while improving self-reported depression and anxiety in patients with bilateral STN DBS. Stimulation in or near the ZI may provide a useful programming setting for patients prone to psychiatric side effects.
已越来越多地认识到丘脑底核（STN）刺激的精神和神经心理学副作用。大多数编程方案都集中在触点 0 和 1，而通常不使用位于或靠近间脑（ZI）的触点 3。ZI 刺激是否可能限制边缘效应的问题尚未得到解答。
通过短期刺激 ZI（触点 3）或使用标准轨迹和靶向刺激 STN，来研究其对边缘系统和运动功能的影响。
采用统一帕金森病评定量表 3、结构化步态视频分析、视觉模拟量表情绪量表、冲动任务测试和面部识别，评估 11 例接受 STN-DBS 的患者的运动和边缘系统功能。常规 STN 编程和 ZI 内或附近刺激下，评估术后磁共振成像确认触点 3 位于 ZI 附近或内部的患者的运动和边缘系统功能。
采用重复测量方差分析进行数据分析，结果显示两种刺激设置下的运动评分均保持稳定，ZI 刺激时手指敲击（P=0.02）和快速交替运动（P=0.03）的特定改善。ZI 附近或内部的刺激导致自我报告的焦虑和抑郁程度降低（两者均为 P=0.03），并且恐惧识别能力提高（P=0.02）。
我们提供了初步证据，表明在双侧 STN-DBS 患者中，ZI 内或附近的刺激可维持运动功能，同时改善自我报告的抑郁和焦虑。ZI 内或附近的刺激可能为易发生精神副作用的患者提供有用的编程设置。
