Department of Clinical Neuroscience, University Hospital of Umeå, Umeå, Sweden.
UCL-Queen Square Institute of Neurology, London, UK.
J Intern Med. 2022 Nov;292(5):764-778. doi: 10.1111/joim.13541. Epub 2022 Jul 13.
Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for eligible patients with advanced disease in whom medical treatment fails to provide adequate symptom control and good quality of life, or in whom dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored to the patient's symptoms and targeted to various nodes along the basal ganglia-thalamus circuitry, which mediates the various symptoms of the illness; DBS in the thalamus is most efficient for tremors, and DBS in the pallidum most efficient for rigidity and dyskinesias, whereas DBS in the subthalamic nucleus (STN) can treat both tremors, akinesia, rigidity and dyskinesias, and allows for decrease in doses of medications even in patients with advanced stages of the disease, which makes it the preferred target for DBS. However, DBS in the STN assumes that the patient is not too old, with no cognitive decline or relevant depression, and does not exhibit severe and medically resistant axial symptoms such as balance and gait disturbances, and falls. Dysarthria is the most common side effect of DBS, regardless of the brain target. DBS has a long-lasting effect on appendicular symptoms, but with progression of disease, nondopaminergic axial features become less responsive to DBS. DBS for PD is highly specialised; to enable adequate selection and follow-up of patients, DBS requires dedicated multidisciplinary teams of movement disorder neurologists, functional neurosurgeons, specialised DBS nurses and neuropsychologists.
帕金森病（PD）是一种进行性神经退行性疾病，既有运动症状，也有非运动症状。深部脑刺激（DBS）是一种成熟的安全神经外科治疗方法，适用于疾病进展期、药物治疗效果不佳、不能有效控制症状和改善生活质量的患者，或药物治疗引起严重副作用（如运动障碍）的患者。DBS 可以根据患者的症状进行调整，并针对基底节-丘脑回路中的不同节点进行靶向治疗，该回路介导疾病的各种症状；丘脑 DBS 对震颤最有效，苍白球 DBS 对僵硬和运动障碍最有效，而丘脑底核（STN）DBS 可以治疗震颤、运动不能、僵硬和运动障碍，并减少药物剂量，即使在疾病晚期的患者中也是如此，这使其成为 DBS 的首选靶点。然而，STN 的 DBS 假设患者年龄不大，没有认知能力下降或相关抑郁，也没有表现出严重和难以治疗的轴性症状，如平衡和步态障碍以及跌倒。构音障碍是 DBS 最常见的副作用，无论大脑靶点如何。DBS 对肢体症状有持久的效果，但随着疾病的进展，非多巴胺能轴性特征对 DBS 的反应性降低。PD 的 DBS 是高度专业化的；为了能够对患者进行充分的选择和随访，DBS 需要由运动障碍神经科医生、功能神经外科医生、专门的 DBS 护士和神经心理学家组成的多学科团队来进行。
