Pallidal versus Subthalamic Deep-Brain Stimulation for Parkinson's Disease
Pallidal versus Subthalamic Deep-Brain Stimulation for Parkinson's Disease
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DOI：
10.1056/nejmoa0907083
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发表时间：
2010-06-03
影响因子：
158.5
通讯作者：
Reda, Domenic J.
中科院分区：
文献类型：
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作者：
Follett, Kenneth A.;Weaver, Frances M.;Reda, Domenic J.
背景脑深部刺激是晚期帕金森病患者的首选外科手术。苍白球和丘脑底核是该手术的公认目标。我们比较了24个月的患者谁经历了双边刺激的苍白球内（苍白球刺激）或丘脑底核（丘脑底核刺激）METHODS在7个退伍军人事务部和6所大学医院，我们随机分配299例原发性帕金森氏病患者进行苍白球刺激（152例）或丘脑底核刺激（147例）。主要结局是运动功能的变化，根据统一帕金森病评定量表第三部分（UMRS-III）进行盲法评估，同时患者接受刺激但未接受抗帕金森病药物治疗。次要结果包括自我报告的功能、生活质量、神经认知功能和不良事件。主要结果的平均变化在两个研究组之间没有显著差异（P=0.50）。自我报告的功能也没有显着差异。接受丘脑底核刺激的患者比接受苍白球刺激的患者需要更低剂量的多巴胺能药物（P=0.02）。刺激丘脑底核后，加工速度的一个组成部分（视觉）比刺激苍白球后下降更多（P=0.03）。刺激丘脑底核后抑郁程度加重，刺激苍白球后抑郁程度改善（P=0.02）。51%接受苍白球刺激的患者和56%接受丘脑底刺激的患者发生严重不良事件，24个月时组间无显着差异。结论帕金森病患者在苍白球刺激或丘脑底刺激后运动功能有类似的改善。脑深部电刺激手术靶点的选择应合理考虑非运动因素。（ClinicalTrials.gov编号，NCT 00056563和NCT 01076452。）
BACKGROUNDDeep-brain stimulation is the surgical procedure of choice for patients with advanced Parkinson's disease. The globus pallidus interna and the subthalamic nucleus are accepted targets for this procedure. We compared 24-month outcomes for patients who had undergone bilateral stimulation of the globus pallidus interna (pallidal stimulation) or subthalamic nucleus (subthalamic stimulation).METHODSAt seven Veterans Affairs and six university hospitals, we randomly assigned 299 patients with idiopathic Parkinson's disease to undergo either pallidal stimulation (152 patients) or subthalamic stimulation (147 patients). The primary outcome was the change in motor function, as blindly assessed on the Unified Parkinson's Disease Rating Scale, part III (UPDRS-III), while patients were receiving stimulation but not receiving antiparkinsonian medication. Secondary outcomes included self-reported function, quality of life, neurocognitive function, and adverse events.RESULTSMean changes in the primary outcome did not differ significantly between the two study groups (P=0.50). There was also no significant difference in self-reported function. Patients undergoing subthalamic stimulation required a lower dose of dopaminergic agents than did those undergoing pallidal stimulation (P=0.02). One component of processing speed (visuomotor) declined more after subthalamic stimulation than after pallidal stimulation (P=0.03). The level of depression worsened after subthalamic stimulation and improved after pallidal stimulation (P=0.02). Serious adverse events occurred in 51% of patients undergoing pallidal stimulation and in 56% of those undergoing subthalamic stimulation, with no significant between-group differences at 24 months.CONCLUSIONSPatients with Parkinson's disease had similar improvement in motor function after either pallidal or subthalamic stimulation. Nonmotor factors may reasonably be included in the selection of surgical target for deep-brain stimulation. (ClinicalTrials.gov numbers, NCT00056563 and NCT01076452.)