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帕金森病深部脑刺激中苍白球内侧部与丘脑底核的比较:机构经验与综述

Comparison of Globus Pallidus Interna and Subthalamic Nucleus in Deep Brain Stimulation for Parkinson Disease: An Institutional Experience and Review.

作者信息

Mirza Shazia, Yazdani Umar, Dewey Iii Richard, Patel Neepa, Dewey Richard B, Miocinovic Svjetlana, Chitnis Shilpa

机构信息

Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA.

Department of Neurology and Neurotherapeutics, Section of Movement Disorders, UT Southwestern, Dallas, TX, USA.

出版信息

Parkinsons Dis. 2017;2017:3410820. doi: 10.1155/2017/3410820. Epub 2017 Jun 19.

Abstract

Deep Brain Stimulation (DBS) has revolutionized the lives of patients of Parkinson disease, offering therapeutic options to those not benefiting entirely from medications alone. With its proven track record of outperforming the best medical management, the goal is to unlock the full potential of this therapy. Currently, the Globus Pallidus Interna (GPi) and Subthalamic Nucleus (STN) are both viable targets for DBS, and the choice of site should focus on the constellation of symptoms, both motor and nonmotor, which are key determinants to quality of life. Our article sheds light on the specific advantages and drawbacks of the two sites, highlighting the need for matching the inherent properties of a target with specific desired effects in patients. UT Southwestern Medical Center has a robust and constantly evolving DBS program and the narrative from our center provides invaluable insight into the practical realities of DBS. The ultimate decision in selecting a DBS target is complex, ideally made by a multidisciplinary team, tailored towards each patient's profile and their expectations, by drawing upon scientific evidence coupled with experience. Ongoing research is expanding our knowledge base, which should be dynamically incorporated into an institute's DBS paradigm to ensure that patients receive the optimal therapy.

摘要

脑深部电刺激术(DBS)彻底改变了帕金森病患者的生活,为那些无法仅从药物治疗中完全获益的患者提供了治疗选择。鉴于其已被证实优于最佳药物治疗管理的记录,目标是充分发挥这种疗法的潜力。目前,内侧苍白球(GPi)和丘脑底核(STN)都是DBS可行的靶点,而靶点的选择应聚焦于运动和非运动症状的组合,这些是生活质量的关键决定因素。我们的文章阐明了这两个靶点的具体优缺点,强调了使靶点的固有特性与患者的特定预期效果相匹配的必要性。德克萨斯大学西南医学中心拥有一个强大且不断发展的DBS项目,我们中心的叙述为DBS的实际情况提供了宝贵的见解。选择DBS靶点的最终决定很复杂,理想情况下应由多学科团队做出,根据科学证据和经验,针对每个患者的情况及其期望进行定制。正在进行的研究正在扩大我们的知识库,应将其动态纳入机构的DBS模式,以确保患者接受最佳治疗。

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