Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
Unit of Occupational Therapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
J Neurol Neurosurg Psychiatry. 2018 Jul;89(7):710-716. doi: 10.1136/jnnp-2017-317219. Epub 2018 Jan 31.
Several open-label studies have shown good effect of deep brain stimulation (DBS) in the caudal zona incerta (cZi) on tremor, including parkinsonian tremor, and in some cases also a benefit on akinesia and axial symptoms. The aim of this study was to evaluate objectively the effect of cZi DBS in patients with Parkinson's disease (PD).
25 patients with PD were randomised to either cZi DBS or best medical treatment. The primary outcomes were differences between the groups in the motor scores of the Unified Parkinson's Disease Rating Scale (UPDRS-III) rated single-blindly at 6 months and differences in the Parkinson's Disease Questionnaire 39 items (PDQ-39). 19 patients, 10 in the medical arm and 9 in the DBS arm, fulfilled the study.
The DBS group had 41% better UPDRS-III scores off-medication on-stimulation compared with baseline, whereas the scores of the non-surgical patients off-medication were unchanged. In the on-medication condition, there were no differences between the groups, neither at baseline nor at 6 months. Subitems of the UPDRS-III showed a robust effect of cZi DBS on tremor. The PDQ-39 domains 'stigma' and 'ADL' improved only in the DBS group. The PDQ-39 summary index improved in both groups.
This is the first randomised blinded evaluation of cZi DBS showing its efficacy on PD symptoms. The most striking effect was on tremor; however, the doses of dopaminergic medications could not be decreased. cZi DBS in PD may be an addition to existing established targets, enabling tailoring the surgery to the needs of the individual patient.
几项开放标签研究表明，尾状核下区（cZi）深部脑刺激（DBS）对震颤有很好的效果，包括帕金森震颤，在某些情况下对运动不能和轴性症状也有好处。本研究旨在评估 cZi DBS 对帕金森病（PD）患者的客观疗效。
25 例 PD 患者随机分为 cZi DBS 组或最佳药物治疗组。主要结局是 6 个月时两组间统一帕金森病评定量表（UPDRS-III）运动评分的差异，以及帕金森病问卷 39 项（PDQ-39）的差异。19 例患者（药物组 10 例，DBS 组 9 例）完成了研究。
DBS 组在刺激下不服用药物时的 UPDRS-III 评分比基线时改善了 41%，而未接受手术的患者不服用药物时的评分则没有变化。在服用药物的情况下，两组之间在基线和 6 个月时均无差异。UPDRS-III 的亚项显示 cZi DBS 对震颤有明显的效果。PDQ-39 的“耻辱感”和“ADL”两个领域仅在 DBS 组中得到改善。PDQ-39 综合指数在两组中均有所改善。
这是首次对 cZi DBS 进行随机盲法评估，显示其对 PD 症状的疗效。最显著的效果是对震颤；然而，多巴胺能药物的剂量不能减少。cZi DBS 治疗 PD 可能是对现有既定靶点的补充，使手术能够根据患者的个体需求进行调整。
