Enatsu Rei, Kitagawa Mayumi, Mikami Takeshi, Kanno Aya, Komura Shoichi, Mikuni Nobuhiro
Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Department of Neurology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan.
NMC Case Rep J. 2019 May 29;6(3):91-93. doi: 10.2176/nmccrj.cr.2018-0277. eCollection 2019 Aug.
Deep brain stimulation (DBS) of the posterior subthalamic nucleus (pSTN), caudal zona incerta (cZI), and prelemniscal radiation (Raprl) has been shown to improve Parkinsonian motor symptoms. We herein report neurophysiological and functional differences among the cZI, Raprl, and pSTN in a 68-year-old male patient with Parkinson's disease (PD). The stereotactic implantation of DBS electrodes in the right STN was performed. Thereafter, a transfrontal trajectory for the left cZI was planned for left side implantation, with the expectation that the electrode entered the pSTN in the case of a posterior brain shift. In the implantation of the DBS lead in the cZI, three microelectrodes were simultaneously placed in an array with the central, medial, and anterior positions placed 2 mm apart to delineate the cZI, Raprl, and pSTN, respectively. A maximal reduction in bradykinesia was obtained from the stimulation of the pSTN at the lowest voltage thresholds, and the voltage threshold for abolishing tremors was lower in the Raprl and cZI than in the pSTN. The left DBS lead was implanted in the pSTN because right-sided bradykinesia was more severe than tremor. The multitrack recording of cZI, Raprl, and pSTN might broaden target selection depending on patients' symptoms.
对丘脑底核后部（pSTN）、未定带尾部（cZI）和丘脑前辐射（Raprl）进行深部脑刺激（DBS）已被证明可改善帕金森病的运动症状。我们在此报告一名68岁帕金森病（PD）男性患者的cZI、Raprl和pSTN之间的神经生理学和功能差异。在右侧丘脑底核进行了DBS电极的立体定向植入。此后，规划了一条经额叶至左侧cZI的轨迹用于左侧植入，预期在脑向后移位的情况下电极会进入pSTN。在将DBS导线植入cZI时，将三个微电极以阵列形式同时放置，中心、内侧和前部位置彼此相距2毫米，分别用于勾勒cZI、Raprl和pSTN。在最低电压阈值下刺激pSTN可最大程度减轻运动迟缓，且Raprl和cZI消除震颤的电压阈值低于pSTN。由于右侧运动迟缓比震颤更严重，因此将左侧DBS导线植入了pSTN。对cZI、Raprl和pSTN进行多轨迹记录可能会根据患者症状拓宽靶点选择范围。
