Department of Pharmacology and Clinical Neuroscience, Division of Neurosurgery, Umeå University, Umeå, Sweden.
Parkinsonism Relat Disord. 2012 Dec;18(10):1062-6. doi: 10.1016/j.parkreldis.2012.05.024. Epub 2012 Jun 17.
The subthalamic nucleus is currently the target of choice in deep brain stimulation (DBS) for Parkinson's disease (PD), while thalamic DBS is used in some cases of tremor-dominant PD. Recently, a number of studies have presented promising results from DBS in the posterior subthalamic area, including the caudal zona incerta (cZi). The aim of the current study was to evaluate cZi DBS in tremor-dominant Parkinson's disease.
14 patients with predominately unilateral tremor-dominant PD and insufficient relief from pharmacologic therapy were included and evaluated according to the motor part of the Unified Parkinson Disease Rating Scale (UPDRS). The mean age was 65 ± 6.1 years and the disease duration 7 ± 5.7 years. Thirteen patients were operated on with unilateral cZi DBS and 1 patient with a bilateral staged procedure. Five patients had non-L-dopa responsive symptoms. The patients were evaluated on/off medication before surgery and on/off medication and stimulation after a minimum of 12 months after surgery.
At the follow-up after a mean of 18.1 months stimulation in the off-medication state improved the contralateral UPDRS III score by 47.7%. Contralateral tremor, rigidity, and bradykinesia were improved by 82.2%, 34.3%, and 26.7%, respectively. Stimulation alone abolished tremor at rest in 10 (66.7%) and action tremor in 8 (53.3%) of the patients.
Unilateral cZi DBS seems to be safe and effective for patients with severe Parkinsonian tremor. The effects on rigidity and bradykinesia were, however, not as profound as in previous reports of DBS in this area.
目前，丘脑下核(subthalamic nucleus)是深部脑刺激(DBS)治疗帕金森病(PD)的首选目标，而在一些震颤为主的 PD 病例中，则采用丘脑刺激。最近，一些研究报告了后丘脑下(subthalamic area)刺激(DBS)的有前景的结果，包括尾状核下带(cZi)。本研究旨在评估 cZi DBS 在以震颤为主的帕金森病中的应用。
14 例以单侧震颤为主且药物治疗效果不佳的 PD 患者纳入本研究，并根据帕金森病评定量表运动部分(UPDRS)进行评估。患者平均年龄为 65±6.1 岁，病程 7±5.7 年。13 例患者接受单侧 cZi DBS 手术，1 例患者行双侧分期手术。5 例患者有非左旋多巴反应性症状。患者术前在药物治疗和不治疗两种状态下进行评估，术后至少 12 个月时在药物治疗和不治疗及刺激两种状态下进行评估。
在平均 18.1 个月的刺激随访期，停药状态下对侧 UPDRS III 评分改善了 47.7%。对侧震颤、僵硬和运动迟缓分别改善了 82.2%、34.3%和 26.7%。刺激单独使 10 例（66.7%）患者的静止性震颤和 8 例（53.3%）患者的动作性震颤完全消除。
单侧 cZi DBS 治疗严重帕金森震颤似乎安全有效，但对僵硬和运动迟缓的疗效不如之前报道的该区域 DBS 治疗。
