Li Jiping, Mei Shanshan, Jia Xiaofei, Zhang Yuqing
Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2021 Apr 12;12:595741. doi: 10.3389/fneur.2021.595741. eCollection 2021.
This study aimed to evaluate the direct anti-dyskinesia effect of deep brain stimulation (DBS) of subthalamic nucleus (STN) on levodopa-induced on-dyskinesia in Parkinson's disease (PD) patients during the early period after surgery without reducing the levodopa dosage. We retrospectively reviewed PD patients who underwent STN-DBS from January 2017 to October 2019 and enrolled patients with levodopa-induced on-dyskinesia before surgery and without a history of thalamotomy or pallidotomy. The Unified Dyskinesia Rating Scale (UDysRS) parts I+III+IV and the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) were monitored prior to surgery, and at the 3-month follow-up, the location of active contacts was calculated by postoperative CT-MRI image fusion to identify stimulation sites with good anti-dyskinesia effect. There were 41 patients enrolled. The postoperative levodopa equivalent daily dose (LEDD) (823.1 ± 201.5 mg/day) was not significantly changed from baseline (844.6 ± 266.1 mg/day, = 0.348), while the UDysRS on-dyskinesia subscores significantly decreased from 24 (10-58) to 0 (0-18) [median (range)] after STN stimulation ( < 0.0001). The levodopa-induced on-dyskinesia recurred in stimulation-off/medication-on state in all the 41 patients and disappeared in 39 patients when DBS stimulation was switched on at 3 months of follow-up. The active contacts which correspond to good effect for dyskinesia were located above the STN, and the mean coordinate was 13.05 ± 1.24 mm lateral, -0.13 ± 1.16 mm posterior, and 0.72 ± 0.78 mm superior to the midcommissural point. High-frequency electrical stimulation of the area above the STN can directly suppress levodopa-induced on-dyskinesia.
本研究旨在评估在不减低左旋多巴剂量的情况下，帕金森病（PD）患者术后早期丘脑底核（STN）深部脑刺激（DBS）对左旋多巴诱导的异动症的直接抗异动症作用。我们回顾性分析了2017年1月至2019年10月期间接受STN-DBS的PD患者，并纳入术前有左旋多巴诱导的异动症且无丘脑切开术或苍白球切开术病史的患者。术前及3个月随访时监测统一异动症评定量表（UDysRS）的I+III+IV部分以及统一帕金森病评定量表第三部分（UPDRS-III），通过术后CT-MRI图像融合计算有效触点的位置，以确定具有良好抗异动症效果的刺激部位。共纳入41例患者。术后左旋多巴等效日剂量（LEDD）（823.1±201.5mg/天）与基线（844.6±266.1mg/天，P=0.348）相比无显著变化，而STN刺激后UDysRS异动症分项评分从24（10-58）显著降至0（0-18）[中位数（范围）]（P<0.0001）。41例患者在刺激关闭/服药开启状态下左旋多巴诱导的异动症均复发，在随访3个月开启DBS刺激时，39例患者的异动症消失。对异动症有良好效果的有效触点位于STN上方，平均坐标为相对于联合中点外侧13.05±1.24mm、后方-0.13±1.16mm、上方0.72±0.78mm。STN上方区域的高频电刺激可直接抑制左旋多巴诱导的异动症。
