帕金森病患者背侧苍白球内侧部/苍白球外侧部刺激诱发的异动症
Dorsal GPi/GPe Stimulation Induced Dyskinesia in a Patient with Parkinson's Disease.
作者信息
Elkouzi Ahmad, Tsuboi Takashi, Burns Matthew R, Eisinger Robert S, Patel Amar, Deeb Wissam
机构信息
Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA.
Fixel Institute for Neurological Diseases, Gainesville, FL, USA.
出版信息
Tremor Other Hyperkinet Mov (N Y). 2019 Sep 6;9. doi: 10.7916/tohm.v0.685. eCollection 2019.
CLINICAL VIGNETTE
A 68-year-old man with Parkinson's disease (PD) had bilateral GPi DBS placed for management of his motor fluctuations. He developed stimulation-induced dyskinesia (SID) with left dorsal GPi stimulation.
CLINICAL DILEMMA
What do we know about SID in PD patients with GPi DBS? What are the potential strategies used to maximize the DBS therapeutic benefit and minimize the side effects of stimulation?
CLINICAL SOLUTION
Avoiding the contact implicated in SID and programming more ventral contacts, using lower voltage, frequency and pulse width and programming in bipolar configuration all appear to help minimize the SID and provide appropriate symptomatic motor control.
GAP IN KNOWLEDGE
Little is known about SID in patients with PD who had GPi DBS therapy. More studies using volume of tissue activated and diffusion tensor imaging MRI are needed to localize specific tracts in or around the GPi that may be implicated in SID.
临床病例
一名68岁的帕金森病（PD）患者接受了双侧苍白球内侧核（GPi）脑深部电刺激（DBS）治疗以控制其运动波动。在对左侧GPi进行刺激时，他出现了刺激诱导性异动症（SID）。
临床困境
我们对接受GPi DBS治疗的PD患者的SID了解多少？用于最大化DBS治疗益处并最小化刺激副作用的潜在策略有哪些？
临床解决方案
避免使用与SID相关的电极触点，并将更多腹侧触点进行程控，使用较低的电压、频率和脉冲宽度，并采用双极配置进行程控，所有这些似乎都有助于最小化SID并提供适当的症状性运动控制。
知识空白
对于接受GPi DBS治疗的PD患者的SID了解甚少。需要更多使用组织激活体积和扩散张量成像MRI的研究来定位GPi内或其周围可能与SID相关的特定神经束。
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