深部脑刺激苍白球内侧、丘脑底核和脑桥被盖核治疗帕金森病:选择哪个靶点?

Deep brain stimulation of globus pallidus interna, subthalamic nucleus, and pedunculopontine nucleus for Parkinson's disease: which target?

机构信息

Division of Neurosurgery, University of Nebraska Medical Center, Omaha, NE 68198, USA.

出版信息

Parkinsonism Relat Disord. 2012 Jan;18 Suppl 1:S165-7. doi: 10.1016/S1353-8020(11)70051-7.

Abstract

Deep brain stimulation (DBS) is an accepted therapy for people with Parkinson's disease (PD) motor symptoms that are refractory to pharmacologic therapy. Standard DBS targets are globus pallidus interna (GPi) and subthalamic nucleus (STN). The pedunculopontine nucleus (PPN) is being investigated as a novel target. Which target provides the best outcomes is unknown. The utility of GPi and STN as targets has been confirmed in numerous studies, including randomized comparisons of GPi DBS and STN DBS that demonstrated no difference in motor outcomes. DBS at either site improves appendicular motor symptoms, but beneficial effects on axial manifestations of PD such as postural instability or gait dysfunction (PIGD) are less apparent. PPN has been introduced as a DBS target due to failure of GPi and STN DBS to improve PIGD. Small observational studies indicate improved PIGD with PPN DBS, but small blinded trials show only subjective reduction in falls with no other impact on PIGD or other PD manifestations. No single DBS target is superior to the others. Each target offers relative advantages. Further studies are needed to better define the roles of each target, particularly PPN. Choice of target should be individualized according to providers' preferences and patients' needs.

摘要

脑深部电刺激(DBS)是一种已被接受的治疗方法,适用于对药物治疗无效的帕金森病(PD)运动症状患者。标准的 DBS 靶点是苍白球内侧(GPi)和丘脑底核(STN)。动眼神经核(PPN)正被作为一个新的靶点进行研究。哪个靶点能提供最好的结果尚不清楚。GPi 和 STN 作为靶点的效用已在众多研究中得到证实,包括 GPi DBS 和 STN DBS 的随机比较研究,这些研究表明在运动结果方面没有差异。在这两个部位进行 DBS 均可改善肢体运动症状,但对 PD 的轴向表现,如姿势不稳或步态功能障碍(PIGD)的有益影响则不那么明显。由于 GPi 和 STN DBS 未能改善 PIGD,因此引入 PPN 作为 DBS 靶点。小型观察性研究表明 PPN DBS 可改善 PIGD,但小型盲法试验仅显示跌倒次数主观减少,对 PIGD 或其他 PD 表现没有其他影响。没有一个 DBS 靶点优于其他靶点。每个靶点都有相对的优势。需要进一步的研究来更好地定义每个靶点的作用,特别是 PPN。目标的选择应根据提供者的偏好和患者的需求个体化。

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