Katayama Y, Fukaya C, Yamamoto T
Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
Stereotact Funct Neurosurg. 1997;69(1-4 Pt 2):73-9. doi: 10.1159/000099855.
The effects of deep brain or epidural cortical stimulation on poststroke involuntary and voluntary movement disorders were analyzed in a total of 64 patients. Among them, 22 patients underwent either deep brain or epidural cortical stimulation in order to control their poststroke involuntary movements. The remaining 42 underwent epidural cortical stimulation for the purpose of controlling their poststroke pain. In the latter group of patients, we analyzed the changes in coexistent involuntary or voluntary movement disorders during stimulation for pain control. Stimulation of either the thalamic nucleus ventralis intermedius or the motor cortex proved to be useful in 13 (59%) of the patients who underwent deep brain or epidural cortical stimulation for control of poststroke involuntary movements. Satisfactory control was often achieved in patients with hemiballismus, hemichorea or resting tremor. In 8 (19%) of the patients who underwent epidural cortical stimulation for pain control, stimulation of the motor cortex improved motor performance which had been impaired in association with hemiparesis. Such an effect was independent of pain control and apparently resulted from an inhibition of their rigidity. We believe that these findings justify further clinical studies on deep brain or epidural cortical stimulation for the control of poststroke movement disorders.
对总共64例患者分析了深部脑刺激或硬膜外皮质刺激对中风后不自主和自主运动障碍的影响。其中，22例患者接受了深部脑刺激或硬膜外皮质刺激以控制中风后的不自主运动。其余42例接受硬膜外皮质刺激以控制中风后的疼痛。在后者这组患者中，我们分析了在为控制疼痛而进行刺激期间共存的不自主或自主运动障碍的变化。对于接受深部脑刺激或硬膜外皮质刺激以控制中风后不自主运动的患者，刺激丘脑腹中间核或运动皮层在13例（59%）中被证明是有效的。患有偏侧投掷症、偏侧舞蹈症或静止性震颤的患者通常能实现满意的控制。在接受硬膜外皮质刺激以控制疼痛的患者中，8例（19%）患者刺激运动皮层改善了与偏瘫相关的受损运动表现。这种效果与疼痛控制无关，显然是由于对其僵硬的抑制所致。我们认为这些发现为进一步开展关于深部脑刺激或硬膜外皮质刺激以控制中风后运动障碍的临床研究提供了依据。
