School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
J Neurol Neurosurg Psychiatry. 2012 Feb;83(2):164-70. doi: 10.1136/jnnp-2011-300008. Epub 2011 Sep 2.
Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable.
OBJECTIVES/METHODS: 15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon.
14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior -1.1±1.7 mm, lateral 10.7±1.7 mm and superior -3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients.
The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.
最近的证据表明，丘脑底核深部脑刺激（STN-DBS）可能对早期帕金森病（PD）具有疾病修饰作用。正在进行一项随机、前瞻性研究，以确定早期 PD 中的 STN-DBS 是否安全且可耐受。
目的/方法：在机构审查委员会批准的方案中，30 名早期 PD 患者中有 15 名被随机分配接受 STN-DBS 植入。报告了手术技术、DBS 导联的位置和围手术期不良事件。这些患者使用的活动触点与由同一位外科医生进行的 47 名晚期 PD 患者进行的相同手术进行了比较。
15 名患者中的 14 名没有因手术而遭受任何长期（>3 个月）并发症。一名患者患有中风，导致轻度认知改变和轻微的右臂和面部无力。早期 PD 患者在症状性治疗中使用的平均最佳接触点为：前向-1.1±1.7 毫米，侧向 10.7±1.7 毫米，上方-3.3±2.5 毫米（前、后连合坐标）。这个位置在统计学上与在治疗 47 名晚期 PD 患者中使用的最佳接触点没有显著差异（0.77 毫米，p>0.05）。
本试验中早期 PD 患者的围手术期不良事件与 STN-DBS 在晚期 PD 中报告的不良事件相当。早期 PD 中使用的活动接触位置与晚期疾病中使用的位置没有显著差异。这是第一项关于早期治疗 PD 的随机、手术与最佳药物治疗试验的手术经验报告。
