Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Parkinsonism Relat Disord. 2019 Jul;64:118-123. doi: 10.1016/j.parkreldis.2019.03.009. Epub 2019 Mar 16.
Pallidal deep brain stimulation (DBS) has shown to be beneficial in patients with advanced levodopa-responsive Parkinson's disease (PD) in several short-term studies. However, reported long-term outcomes of pallidal DBS for PD are limited and contradictory.
Eighteen consecutive PD patients were treated with unilateral or bilateral stimulation of the internal part of the globus pallidus (GPi). Assessments were carried out before and six months after neurosurgery, and annually thereafter for up to 16 years (mean follow-up time: 6 years). Primary outcomes included motor signs (Unified PD Rating Scale [UPDRS]-III), activities of daily living (ADL, UPDRS-II), and levodopa-induced motor complications (UPDRS-IV).
The results show that GPi stimulation improves levodopa-responsive PD motor signs (UPDRS-III), levodopa-induced motor complications (UPDRS-IV), and ADL (UPDRS-II) in advanced PD. Among motor signs, tremor showed the best response to pallidal stimulation. Levodopa-induced motor complications and tremor showed improvements for more than 10 years after neurosurgery.
The overall findings in our cohort demonstrate that pallidal stimulation is effective in reducing parkinsonian motor signs (UPDRS-III), particularly in the 'off'-medication state. Although the beneficial effects on bradykinesia, rigidity and ADL may be limited to 5-6 years, the follow up results indicate that the improvements of levodopa-induced motor complications (UPDRS-IV) and tremor can be sustained for more than 10 years.
在几项短期研究中，苍白球深部脑刺激（DBS）已被证明对晚期左旋多巴反应性帕金森病（PD）患者有益。然而，苍白球 DBS 治疗 PD 的长期结果报道有限且相互矛盾。
18 例连续 PD 患者接受单侧或双侧内苍白球（GPi）刺激治疗。在神经外科前后进行评估，此后每年进行一次评估，最长达 16 年（平均随访时间：6 年）。主要结局包括运动症状（统一帕金森病评定量表[UPDRS]-III）、日常生活活动（ADL，UPDRS-II）和左旋多巴诱导的运动并发症（UPDRS-IV）。
结果表明，GPi 刺激可改善晚期 PD 患者的左旋多巴反应性运动症状（UPDRS-III）、左旋多巴诱导的运动并发症（UPDRS-IV）和 ADL（UPDRS-II）。在运动症状中，震颤对苍白球刺激的反应最好。手术后 10 多年，左旋多巴诱导的运动并发症和震颤均有改善。
我们队列的总体发现表明，苍白球刺激可有效降低帕金森病运动症状（UPDRS-III），特别是在“关”药状态下。尽管对运动迟缓和僵硬以及 ADL 的有益作用可能仅限于 5-6 年，但随访结果表明，左旋多巴诱导的运动并发症（UPDRS-IV）和震颤的改善可持续 10 年以上。
