Mostofi Abteen, Evans Julian M, Partington-Smith Lucy, Yu Kenny, Chen Cliff, Silverdale Monty A
1Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Stott Lane, Salford, Greater Manchester M6 8HD UK.
2Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
NPJ Parkinsons Dis. 2019 Aug 21;5:17. doi: 10.1038/s41531-019-0089-1. eCollection 2019.
Both subthalamic nucleus (STN) and caudal zona incerta (cZI) have been implicated as the optimal locus for deep brain stimulation (DBS) in Parkinson's disease (PD). We present a retrospective clinico-anatomical analysis of outcomes from DBS targeting both STN and cZI. Forty patients underwent bilateral DBS using an image-verified implantable guide tube/stylette technique. Contacts on the same quadripolar lead were placed in both STN and cZI. After pulse generator programming, contacts yielding the best clinical effect were selected for chronic stimulation. OFF-medication unified PD rating scale (UPDRS) part III scores pre-operatively and ON-stimulation at 1-2 year follow up were compared. Active contacts at follow-up were anatomically localised from peri-operative imaging. Overall, mean UPDRS part III score improvement was 55 ± 9% (95% confidence interval), with improvement in subscores for rigidity (59 ± 13%), bradykinesia (58 ± 13%), tremor (71 ± 24%) and axial features (36 ± 19%). Active contacts were distributed in the following locations: (1) within posterior/dorsal STN (50%); (2) dorsal to STN (24%); (3) in cZI (21%); and (4) lateral to STN (5%). When contacts were grouped by location, no significant differences between groups were seen in baseline or post-operative improvement in contralateral UPDRS part III subscores. We conclude that when both STN and cZI are targeted, active contacts are distributed most commonly within and immediately dorsal to STN. In a subgroup of cases, cZI contacts were selected for chronic stimulation in preference. Dual targeting of STN and cZI is feasible and may provide extra benefit compared with conventional STN DBS is some patients.
丘脑底核（STN）和尾侧未定带（cZI）均被认为是帕金森病（PD）深部脑刺激（DBS）的最佳靶点。我们对针对STN和cZI的DBS治疗结果进行了回顾性临床解剖学分析。40例患者采用图像验证的可植入导管/探针技术进行双侧DBS。同一四极电极上的触点分别置于STN和cZI。在进行脉冲发生器编程后，选择产生最佳临床效果的触点进行长期刺激。比较术前未用药时的帕金森病统一评分量表（UPDRS）第三部分得分与随访1 - 2年时刺激开启状态下的得分。通过术中成像对随访时的有效触点进行解剖定位。总体而言，UPDRS第三部分得分平均改善55±9%（95%置信区间），其中强直亚评分改善59±13%，运动迟缓亚评分改善58±13%，震颤亚评分改善71±24%，轴性症状亚评分改善36±19%。有效触点分布在以下位置：（1）STN后部/背侧内（50%）；（2）STN背侧（24%）；（3）cZI内（21%）；（4）STN外侧（5%）。当按位置对触点进行分组时，各小组之间在对侧UPDRS第三部分亚评分的基线或术后改善方面未见显著差异。我们得出结论，当同时针对STN和cZI时，有效触点最常见于STN内及其紧邻的背侧。在一部分病例中，优先选择cZI触点进行长期刺激。与传统的STN - DBS相比，可以同时针对STN和cZI进行刺激，对部分患者可能带来额外益处。
