Ramdhani Ritesh A, Patel Amar, Swope David, Kopell Brian H
Department of Neurology, Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Neuromodulation. 2015 Dec;18(8):664-9. doi: 10.1111/ner.12288. Epub 2015 Apr 1.
Deep brain stimulation (DBS) is effective in treating the segmental symptoms of Parkinson's disease (PD) as well as axial symptoms that are levodopa responsive. PD patients on chronic DBS who develop axial symptoms and gait disturbances several years later oftentimes are refractory to high frequency stimulation (HFS). Several studies report benefit produced by low frequency subthalamic nucleus (STN) stimulation in such patients, though the sustainability of the effects has been mixed.
To report the clinical outcomes of a series of patients with Parkinson's disease and levodopa responsive axial and gait disturbances who were switched to 60 Hz stimulation within one year of their DBS surgery.
A retrospective review of 5 patients, whose severe pre-DBS, levodopa responsive gait disorders worsened on HFS STN-DBS and were subsequently switched to 60 Hz stimulation within 1 year of their surgery.
The median age of this cohort was 66 years with median disease duration of 14 years. Four of 5 patients' experienced acute worsening of their axial and gait UPDRS III scores on HFS. All patients' gait disorder improved with 60 Hz along with amelioration of their segmental symptoms and reduction of their levodopa induced dyskinesia. The median time on HFS prior to switching to 60 Hz was two months. Stimulation through the ventral contacts was utilized in all patients with relatively modest changes achieved in levodopa equivalent daily dose.
This case series demonstrates the clinical efficacy of utilizing low frequency (60 Hz) STN stimulation early in the DBS programming course in more advanced PD patients with levodopa responsive gait disturbance and freezing of gait. Activation of a broader stimulation field likely contributed to both axial and segmental symptom improvement while possibly aiding in the reduction of dyskinesia.
脑深部电刺激（DBS）在治疗帕金森病（PD）的节段性症状以及对左旋多巴有反应的轴性症状方面是有效的。接受慢性DBS治疗的PD患者在数年后出现轴性症状和步态障碍时，往往对高频刺激（HFS）无效。多项研究报告了低频丘脑底核（STN）刺激对此类患者的益处，尽管效果的可持续性不一。
报告一系列帕金森病患者以及对左旋多巴有反应的轴性和步态障碍患者在DBS手术1年内转换为60Hz刺激后的临床结果。
回顾性分析5例患者，这些患者在DBS术前严重的、对左旋多巴有反应的步态障碍在HFS STN-DBS治疗时恶化，并在术后1年内转换为60Hz刺激。
该队列的中位年龄为66岁，中位病程为14年。5例患者中有4例在HFS时轴性和步态统一帕金森病评定量表（UPDRS）Ⅲ评分急性恶化。所有患者的步态障碍在60Hz刺激时均有改善，同时节段性症状得到改善，左旋多巴诱发的异动症减少。转换为60Hz刺激前HFS的中位时间为2个月。所有患者均采用通过腹侧触点进行刺激，左旋多巴等效日剂量变化相对较小。
该病例系列证明了在DBS程控过程早期，对病情更严重、有左旋多巴反应性步态障碍和步态冻结的PD患者采用低频（60Hz）STN刺激的临床疗效。激活更广泛刺激区域可能有助于改善轴性和节段性症状，同时可能有助于减少异动症。
