Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
Stereotact Funct Neurosurg. 2020;98(2):104-109. doi: 10.1159/000505707. Epub 2020 Feb 25.
Spinal cord stimulation (SCS) is receiving increasing interests for treating pain and gait disorders in patients with Parkinson's disease (PD). In an SCS study, it is hard to apply a double-blind approach, especially at low frequencies, as the stimulation normally induces paresthesia which can be perceived by the patient. We herein demonstrate a case treated with SCS in which a blinding design was accomplished by an accidental dislocation of a stimulation lead. A 73-year-old man with PD was admitted to our hospital because of relapsed low back pain. This was due to the dislocation of a previously implanted SCS lead, which caused a decrease in its effectiveness in alleviating pain (from 81 to 43% measured by King's Parkinson's Disease Pain Scale) and improving gait (from 35 to 28% measured by the timed up and go test). A second SCS surgery using a paddle lead solved this problem, with improvements in pain and gait rebounded to 81 and 45%. In this case, the paresthesia induced by SCS (using either a paddle lead or percutaneous leads) was below the threshold of perception when the patient was sitting and standing, and a dislocation of one previously implanted percutaneous lead did not cause evident changes in his sensation of paresthesia. At last follow-up, the patient's quality of life had improved by 40% as measured by the 8-item Parkinson's Disease questionnaire (PDQ-8). This study could serve partly as a proof that low-frequency SCS is effective in improving pain as well as gait problems in PD patients, which was unlikely a result of a placebo effect.
脊髓刺激（SCS）在治疗帕金森病（PD）患者的疼痛和步态障碍方面越来越受到关注。在 SCS 研究中，很难采用双盲方法，尤其是在低频下，因为刺激通常会引起感觉异常，患者可以感知到。我们在此展示了一个使用 SCS 治疗的病例，通过刺激导线的意外脱位实现了盲法设计。一名 73 岁的男性 PD 患者因复发性腰痛入住我院。这是由于先前植入的 SCS 导线脱位引起的，这降低了其缓解疼痛（根据 King's Parkinson's Disease Pain Scale 测量，从 81%降至 43%）和改善步态（根据 timed up and go 测试测量，从 35%降至 28%）的效果。使用板状导线进行第二次 SCS 手术解决了这个问题，疼痛和步态均得到改善，分别反弹至 81%和 45%。在这种情况下，当患者坐着和站着时，SCS 引起的感觉异常（使用板状导线或经皮导线）低于感知阈值，一个先前植入的经皮导线脱位不会引起感觉异常的明显变化。在最后一次随访时，患者的生活质量通过帕金森病问卷（PDQ-8）的 8 项测量提高了 40%。这项研究可以部分证明低频 SCS 有效改善 PD 患者的疼痛和步态问题，这不太可能是安慰剂效应的结果。
