晚期帕金森病中丘脑底核的电刺激

Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease.

作者信息

Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid A L

机构信息

Department of Clinical and Biologic Neurosciences, Joseph Fourier University, Grenoble, France.

出版信息

N Engl J Med. 1998 Oct 15;339(16):1105-11. doi: 10.1056/NEJM199810153391603.

DOI:10.1056/NEJM199810153391603

PMID:9770557

Abstract

BACKGROUND

In many patients with idiopathic Parkinson's disease, treatment with levodopa is complicated by fluctuations between an "off" period, when the medication is not working and the motor symptoms of parkinsonism are present, and an "on" period, when the medication is causing improved mobility, often accompanied by debilitating dyskinesias. In animal models of Parkinson's disease, there is overactivity in the subthalamic nucleus, and electrical stimulation of the subthalamic nucleus improves parkinsonism. We therefore sought to determine the efficacy and safety of electrical stimulation of the subthalamic nucleus in patients with Parkinson's disease.

METHODS

We studied 24 patients with idiopathic Parkinson's disease in whom electrodes were implanted bilaterally in the subthalamic nucleus under stereotactic guidance with imaging and electrophysiologic testing of the location. Twenty were followed for at least 12 months. Clinical evaluations included the Unified Parkinson's Disease Rating Scale, a dyskinesia scale, and timed tests conducted before and after surgery, when patients were off and on medications.

RESULTS

After one year of electrical stimulation of the subthalamic nucleus, the patients' scores for activities of daily living and motor examination scores (Unified Parkinson's Disease Rating Scale parts II and III, respectively) off medication improved by 60 percent (P<0.001). The subscores improved for limb akinesia, rigidity, tremor, and gait. In the testing done on medication, the scores on part III improved by 10 percent (P<0.005). The mean dose of dopaminergic drugs was reduced by half. The cognitive-performance scores remained unchanged, but one patient had paralysis and aphasia after an intracerebral hematoma during the implantation procedure.

CONCLUSIONS

Electrical stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson's disease. The severity of symptoms off medication decreases, and the dose of levodopa can be reduced with consequent reduction in dyskinesias.

摘要

背景

在许多特发性帕金森病患者中，左旋多巴治疗会因“关”期和“开”期之间的波动而变得复杂。“关”期时药物不起作用，帕金森病的运动症状出现；“开”期时药物使运动能力改善，但常伴有使人衰弱的运动障碍。在帕金森病动物模型中，丘脑底核存在活动过度，对丘脑底核进行电刺激可改善帕金森病症状。因此，我们试图确定对帕金森病患者丘脑底核进行电刺激的疗效和安全性。

方法

我们研究了24例特发性帕金森病患者，在立体定向引导下双侧将电极植入丘脑底核，并通过影像学和电生理测试确定电极位置。其中20例患者随访至少12个月。临床评估包括统一帕金森病评定量表、运动障碍量表，以及在手术前后患者停药和服药时进行的定时测试。

结果

对丘脑底核进行一年电刺激后，患者停药时的日常生活活动评分和运动检查评分（分别为统一帕金森病评定量表的第二部分和第三部分）提高了60%（P<0.001）。肢体运动不能、僵硬、震颤和步态的子评分均有所改善。在服药测试中，第三部分的评分提高了10%（P<0.005）。多巴胺能药物的平均剂量减少了一半。认知表现评分保持不变，但有1例患者在植入手术过程中发生脑内血肿后出现偏瘫和失语。