Movement Disorder Center and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2011 Oct;26(10):1344-55. doi: 10.3346/jkms.2011.26.10.1344. Epub 2011 Oct 1.
We compared the surgical outcome with electrode positions after bilateral subthalamic nucleus (STN) stimulation surgery for Parkinson's disease. Fifty-seven patients treated with bilateral STN stimulations were included in this study. Electrode positions were determined in the fused images of preoperative MRI and postoperative CT taken at six months after surgery. The patients were divided into three groups: group I, both electrodes in the STN; group II, only one electrode in the STN; group III, neither electrode in the STN. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr stage, and activities of daily living scores significantly improved at 6 and 12 months after STN stimulation in both group I and II. The off-time UPDRS III speech subscore significantly improved (1.6 ± 0.7 at baseline vs 1.3 ± 0.8 at 6 and 12 months, P < 0.01) with least L-dopa equivalent daily dose (LEDD) (844.6 ± 364.1 mg/day at baseline; 279.4 ± 274.6 mg/day at 6 months; and 276.0 ± 301.6 mg/day at 12 months, P < 0.001) at 6 and 12 months after STN deep brain stimulation (DBS) in the group I. Our findings suggest that the better symptom relief including speech with a reduced LEDD is expected in the patients whose electrodes are accurately positioned in both STN.
我们比较了双侧丘脑底核（STN）刺激手术后电极位置与帕金森病手术结果。本研究纳入了 57 例接受双侧 STN 刺激治疗的患者。电极位置是在术后 6 个月的 MRI 与 CT 融合图像上确定的。患者分为三组：I 组，两个电极都在 STN 内；II 组，只有一个电极在 STN 内；III 组，两个电极都不在 STN 内。I 组和 II 组患者在 STN 刺激后 6 个月和 12 个月时，统一帕金森病评定量表（UPDRS）、Hoehn 和 Yahr 分期以及日常生活活动评分均显著改善。STN 刺激后 6 个月和 12 个月时，III 期非运动症状 UPDRS 言语亚评分显著改善（基线时为 1.6 ± 0.7，6 个月时为 1.3 ± 0.8，12 个月时为 1.3 ± 0.8，P < 0.01），左旋多巴等效日剂量（LEDD）最低（基线时为 844.6 ± 364.1 mg/天；6 个月时为 279.4 ± 274.6 mg/天；12 个月时为 276.0 ± 301.6 mg/天，P < 0.001）。我们的研究结果表明，双侧 STN 电极位置准确的患者有望获得更好的症状缓解，包括言语改善和 LEDD 降低。
