Nozaki Takao, Asakawa Tetsuya, Sugiyama Kenji, Koda Yuki, Shimoda Ayumi, Mizushima Takashi, Sameshima Tetsuro, Namba Hiroki
Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
World Neurosurg. 2018 Jul;115:e206-e217. doi: 10.1016/j.wneu.2018.04.014. Epub 2018 Apr 11.
The efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on dexterity remains controversial despite its recognition as an effective strategy for Parkinson disease. The present study investigated the efficacy of STN-DBS for ameliorating bradykinesia and dexterity compared with dopaminergic medications.
Part III of the Unified Parkinson's Disease Rating Scale was used for the evaluation of bradykinesia, whereas the Purdue Pegboard Test and the Box and Block test were selected for dexterity.
Our findings indicate that bradykinesia is significantly improved with both DBS and dopaminergic medication, whereas dexterity is improved only with DBS. Dopaminergic medication did not show a satisfactory efficacy on dexterity, and there was little synergistic effect of dopaminergic medication and STN-DBS for improving dexterity associated with Parkinson disease.
Our results suggest that DBS is potentially more effective than dopaminergic medications for improving dexterity. The disparities in efficacy for bradykinesia and dexterity between DBS and dopaminergic medication hint at the potential mechanisms of STN-DBS. We speculate that DBS follows at least 2 different mechanisms for improving parkinsonian symptoms: 1) the dopaminergic system, primarily for the improvement of bradykinesia and 2) the nondopaminergic system, for the improvement of dexterity. This hypothesis requires further verification and investigation.
尽管丘脑底核（STN）深部脑刺激（DBS）被认为是治疗帕金森病的有效策略，但其对灵活性的疗效仍存在争议。本研究调查了与多巴胺能药物相比，STN-DBS改善运动迟缓及灵活性的疗效。
采用统一帕金森病评定量表第三部分评估运动迟缓，选择普渡钉板试验和方块积木测试评估灵活性。
我们的研究结果表明，DBS和多巴胺能药物均可显著改善运动迟缓，但只有DBS能改善灵活性。多巴胺能药物对灵活性未显示出令人满意的疗效，且多巴胺能药物与STN-DBS在改善帕金森病相关灵活性方面几乎没有协同作用。
我们的结果表明，在改善灵活性方面，DBS可能比多巴胺能药物更有效。DBS与多巴胺能药物在运动迟缓及灵活性疗效上的差异提示了STN-DBS的潜在机制。我们推测，DBS改善帕金森症状至少有两种不同机制：1）多巴胺能系统，主要改善运动迟缓；2）非多巴胺能系统，改善灵活性。这一假设需要进一步验证和研究。
