Bejjani B, Damier P, Arnulf I, Bonnet A M, Vidailhet M, Dormont D, Pidoux B, Cornu P, Marsault C, Agid Y
Centre d'Investigation Clinique-Fédération de Neurologie, Paris, France.
Neurology. 1997 Dec;49(6):1564-9. doi: 10.1212/wnl.49.6.1564.
There has been renewed interest in functional surgery as treatment for Parkinson's disease (PD). Although pallidotomy and chronic pallidal stimulation are highly effective in suppressing levodopa-induced dyskinesia (LID), both methods also seem to be effective in reducing parkinsonian disability. However, the simultaneous improvement of LID and motor signs is hard to explain with the classic model of basal ganglia circuitry. Taking advantage of the fact that deep brain stimulation is reversible and that implanted electrodes contain four discrete stimulation sites, we investigated the effect of stimulation on different sites of the globus pallidus (GP) in five PD patients. Stimulation in the dorsal GP (upper contact) significantly improved gait, akinesia, and rigidity and could induce dyskinesia when patients were in the "off" state. In contrast, stimulation in the posteroventral GP (lower contact) significantly worsened gait and akinesia, although the reduction in rigidity remained. For patients in the "on" state, stimulation in the posteroventral GP dramatically reduced LID but, as in the "off" state, worsened gait and akinesia, thus canceling out the antiparkinsonian effect of levodopa. Our results indicate that stimulation had a striking different effect on parkinsonism and dyskinesia when applied at two different loci of the GP and that stimulation applied in the posteroventral GP produced opposite effects on rigidity and on akinesia. We conclude that parkinsonian signs and LID are a reflection of at least two different anatomofunctional systems within the GP and that this functional organization of the GP needs to be considered when determining the optimal target for surgical treatment of PD.
功能性手术作为帕金森病（PD）的治疗方法再次引起了人们的关注。尽管苍白球切开术和慢性苍白球刺激在抑制左旋多巴诱导的异动症（LID）方面非常有效，但这两种方法似乎在减轻帕金森病残疾方面也很有效。然而，经典的基底神经节回路模型很难解释LID和运动症状的同时改善。利用深部脑刺激是可逆的这一事实以及植入电极包含四个离散刺激位点，我们研究了刺激对五名PD患者苍白球（GP）不同部位的影响。刺激背侧GP（上部触点）可显著改善步态、运动不能和僵硬，并且在患者处于“关”状态时可诱发异动症。相比之下，刺激后腹侧GP（下部触点）虽然僵硬程度仍有减轻，但步态和运动不能显著恶化。对于处于“开”状态的患者，刺激后腹侧GP可显著减少LID，但与“关”状态一样，步态和运动不能恶化，从而抵消了左旋多巴的抗帕金森病作用。我们的结果表明，在GP的两个不同部位进行刺激时，对帕金森病和异动症产生的影响截然不同，并且在后腹侧GP进行刺激对僵硬和运动不能产生相反的作用。我们得出结论，帕金森病体征和LID至少反映了GP内两个不同的解剖功能系统，并且在确定PD手术治疗的最佳靶点时需要考虑GP的这种功能组织。
