Sleep and Movement Disorder Division, University of Utah, Salt Lake City, Utah, USA.
Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
Mov Disord. 2019 Nov;34(11):1722-1727. doi: 10.1002/mds.27839. Epub 2019 Sep 4.
In patients with Parkinson's disease, stimulation above the subthalamic nucleus (STN) may engage the pallidofugal fibers and directly suppress dyskinesia.
The objective of this study was to evaluate the effect of interleaving stimulation through a dorsal deep brain stimulation contact above the STN in a cohort of PD patients and to define the volume of tissue activated with antidyskinesia effects.
We analyzed the Core Assessment Program for Surgical Interventional Therapies dyskinesia scale, Unified Parkinson's Disease Rating Scale parts III and IV, and other endpoints in 20 patients with interleaving stimulation for management of dyskinesia. Individual models of volume of tissue activated and heat maps were used to identify stimulation sites with antidyskinesia effects.
The Core Assessment Program for Surgical Interventional Therapies dyskinesia score in the on medication phase improved 70.9 ± 20.6% from baseline with noninterleaved settings (P < 0.003). With interleaved settings, dyskinesia improved 82.0 ± 27.3% from baseline (P < 0.001) and 61.6 ± 39.3% from the noninterleaved phase (P = 0.006). The heat map showed a concentration of volume of tissue activated dorsally to the STN during the interleaved setting with an antidyskinesia effect.
Interleaved deep brain stimulation using the dorsal contacts can directly suppress dyskinesia, probably because of the involvement of the pallidofugal tract, allowing more conservative medication reduction. © 2019 International Parkinson and Movement Disorder Society.
在帕金森病患者中，刺激丘脑底核（STN）上方可能会激活苍白球传出纤维并直接抑制运动障碍。
本研究旨在评估在一组帕金森病患者中通过 STN 上方的背深部脑刺激触点进行交错刺激的效果，并确定具有抗运动障碍作用的组织激活体积。
我们分析了 20 例采用交错刺激治疗运动障碍的患者的 Core Assessment Program for Surgical Interventional Therapies 运动障碍量表、统一帕金森病评定量表第三部分和第四部分以及其他终点。使用组织激活体积的个体模型和热图来识别具有抗运动障碍作用的刺激部位。
在药物治疗阶段，Core Assessment Program for Surgical Interventional Therapies 运动障碍评分与非交错设置相比基线改善了 70.9 ± 20.6%（P < 0.003）。采用交错设置时，运动障碍与基线相比改善了 82.0 ± 27.3%（P < 0.001），与非交错阶段相比改善了 61.6 ± 39.3%（P = 0.006）。热图显示在交错设置期间 STN 上方背侧有一个激活体积的集中区，具有抗运动障碍作用。
使用背侧触点进行交错深部脑刺激可以直接抑制运动障碍，可能是因为苍白球传出束的参与，从而允许更保守的药物剂量减少。 © 2019 国际帕金森病和运动障碍协会。
