Krack P, Benazzouz A, Pollak P, Limousin P, Piallat B, Hoffmann D, Xie J, Benabid A L
Department of Clinical and Biological Neurosciences, Centre Hospitalier Universitaire, Grenoble, France.
Mov Disord. 1998 Nov;13(6):907-14. doi: 10.1002/mds.870130608.
The recent resurgent interest in functional surgery for the treatment of Parkinson's disease (PD) has focused on the effects on akinesia and levodopa-induced dyskinesia. Stimulation of the subthalamic nucleus (STN) improves akinesia and rigidity but its effects on tremor have not been studied. The objective of this study was to assess the efficacy of STN stimulation on tremor in patients with the complete parkinsonian triad with motor fluctuations. Of 27 consecutive patients with STN stimulation (26 bilateral), 15 exhibited tremor rated at least 2/4 according to item 20 (rest tremor) of the Unified Parkinson's Disease Rating Scale (UPDRS) in at least one limb. The mean preoperative tremor score was 11.3+/-5.6 in off-drug and 1.2+/-2.4 in on-drug conditions. The postoperative tremor scores at the last follow up (from 1-12 months) were 2.2+/-2.2 off-drug/on-stimulation and 0.2+/-0.4 on-drug/on-stimulation. Both rest and action tremors were improved in all patients. The UPDRS tremor score was reduced by 80%, rigidity score by 65%, and akinesia score by 51% on average. For the three symptoms, the stimulation effect was close to that induced before surgery by a suprathreshold dose of levodopa given in the morning. STN stimulation can be considered an interesting alternative to thalamic or internal pallidal surgery even in PD patients with severe high-amplitude tremor. In keeping with electrophysiological data in monkeys rendered parkinsonian by MPTP injections, our results emphasize the importance of the oscillation of a neuronal loop involving the STN in the pathophysiology of parkinsonian tremor.
近期，针对帕金森病（PD）的功能手术治疗重新引发了人们的关注，其重点在于对运动不能和左旋多巴诱发的异动症的影响。刺激丘脑底核（STN）可改善运动不能和强直，但其对震颤的影响尚未得到研究。本研究的目的是评估STN刺激对具有运动波动的完全性帕金森三联征患者震颤的疗效。在连续接受STN刺激的27例患者（26例双侧刺激）中，15例至少有一个肢体的震颤根据统一帕金森病评定量表（UPDRS）第20项（静止性震颤）评定为至少2/4级。术前平均震颤评分在未服药状态下为11.3±5.6，服药状态下为1.2±2.4。最后一次随访（1至12个月）时的术后震颤评分在未服药/刺激状态下为2.2±2.2，服药/刺激状态下为0.2±0.4。所有患者的静止性和动作性震颤均得到改善。UPDRS震颤评分平均降低了80%，强直评分降低了65%，运动不能评分降低了51%。对于这三种症状，刺激效果与术前早晨给予阈上剂量左旋多巴所诱发的效果相近。即使在患有严重高幅度震颤的PD患者中，STN刺激也可被视为丘脑或苍白球内侧部手术的一个有吸引力的替代方案。与用MPTP注射使猴子患帕金森病的电生理数据一致，我们的结果强调了涉及STN的神经元环路振荡在帕金森病震颤病理生理学中的重要性。
