Department of Neurosurgery, Institute of Neurosciences, Frenchay Hospital, Bristol, UK.
Neurology. 2012 Apr 3;78(14):1090-5. doi: 10.1212/WNL.0b013e31824e8e96. Epub 2012 Mar 7.
To assess the effect of deep brain stimulation (DBS) in the pedunculopontine nucleus (PPN) and caudal zona incerta (cZi)-both separately and in combination-on motor symptoms and regional cerebral blood flow (rCBF) in patients with Parkinson disease (PD).
Four patients with bilateral cZi and PPN DBS electrodes were rated with the Unified Parkinson's Disease Rating Scale motor subscale (UPDRS-III) when taking and withdrawn from medication. A block of 16 [(15)O]-H(2)O PET resting measurements of rCBF were performed in 4 different states with patients withdrawn from medication: 1) no stimulation, 2) cZi stimulation alone, 3) PPN stimulation alone, 4) combined PPN/cZi stimulation.
When patients were medicated, combined PPN/cZi stimulation produced a statistically significant improvement in UPDRS-III score compared to cZi stimulation alone. In the "off" medication state, the clinical effect of combined stimulation was not significantly different from that induced by cZi stimulation alone. Concomitant PPN/cZi stimulation had a cumulative effect on levels of rCBF, effectively combining subcortical and cortical changes induced by stimulation of either target in isolation.
These findings suggest that concomitant low frequency stimulation of PPN and cZi regions induces additive brain activation changes and provides improved control of PD symptoms when medicated.
This study provides Class IV evidence that concomitant low frequency stimulation of PPN and cZI improves motor symptoms in patients with PD on dopamine replacement. It provides Class III evidence that concomitant low frequency stimulation of PPN and cZi induces additive rCBF changes in motor areas of brain.
评估单独和联合刺激脑桥被盖核（PPN）和尾壳核（cZi）对帕金森病（PD）患者的运动症状和局部脑血流（rCBF）的影响。
对 4 例双侧 cZi 和 PPN DBS 电极的患者，在停药和服药时使用统一帕金森病评定量表运动评分（UPDRS-III）进行评分。在 4 种不同状态下，对患者进行了 16 个[(15)O]-H(2)O PET 静息 rCBF 测量：1）无刺激，2）单独 cZi 刺激，3）单独 PPN 刺激，4）PPN/cZi 联合刺激。
当患者服药时，与单独 cZi 刺激相比，PPN/cZi 联合刺激在 UPDRS-III 评分上有统计学显著改善。在“停药”状态下，联合刺激的临床效果与单独 cZi 刺激无显著差异。PPN/cZi 联合刺激具有累积效应，有效结合了单独刺激任一靶点引起的皮质下和皮质变化。
这些发现表明，PPN 和 cZi 区域的低频刺激联合应用可诱导大脑激活的附加变化，并在患者服药时提供更好的 PD 症状控制。
本研究提供了 IV 级证据，表明 PPN 和 cZi 区域的低频刺激联合应用可改善多巴胺替代治疗的 PD 患者的运动症状。它提供了 III 级证据，表明 PPN 和 cZi 区域的低频刺激联合应用可诱导大脑运动区的 rCBF 附加变化。
