Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease.
Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease.
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DOI：
10.1056/nejmoa000827
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发表时间：
2001-09-27
影响因子：
158.5
通讯作者：
Wilkinson, S
中科院分区：
文献类型：
--
作者：
Obeso, JA;Guridi, J;Wilkinson, S
工作背景：丘脑底核和苍白球内侧部的神经元活动增加被认为是帕金森病患者运动功能障碍的原因。虽然在这些结构中创建病变可以改善患有诱导性帕金森综合征的猴子和帕金森病患者的运动功能，但这些病变与神经功能缺损相关，特别是当它们是双侧创建时。深部脑刺激模拟病变的影响，而不破坏脑tissue.Methods：我们进行了一项前瞻性，双盲，交叉研究，在晚期帕金森氏病患者，其中电极植入丘脑底核或苍白球内部，然后接受双边高频深部脑刺激。当刺激被随机分配为打开或关闭时，我们比较了统一帕金森病评定量表运动部分的分数。我们进行了非盲的评估运动功能术前和1，3，6个月postoperatives.Results：电极植入双侧在丘脑底核组和38例患者在苍白球组的96例。手术后三个月，双盲交叉评估表明，刺激丘脑底核与运动评分的中位数改善（与无刺激相比）相关49%，刺激苍白球内侧部与运动评分的中位数改善37%相关（P
Background: Increased neuronal activity in the subthalamic nucleus and the pars interna of the globus pallidus is thought to account for motor dysfunction in patients with Parkinson's disease. Although creating lesions in these structures improves motor function in monkeys with induced parkinsonism and patients with Parkinson's disease, such lesions are associated with neurologic deficits, particularly when they are created bilaterally. Deep-brain stimulation simulates the effects of a lesion without destroying brain tissue.Methods: We performed a prospective, double-blind, crossover study in patients with advanced Parkinson's disease, in whom electrodes were implanted in the subthalamic nucleus or pars interna of the globus pallidus and who then underwent bilateral high-frequency deep-brain stimulation. We compared scores on the motor portion of the Unified Parkinson's Disease Rating Scale when the stimulation was randomly assigned to be turned on or off. We performed unblinded evaluations of motor function preoperatively and one, three, and six months postoperatively.Results: Electrodes were implanted bilaterally in 96 patients in the subthalamic-nucleus group and 38 patients in the globus-pallidus group. Three months after the procedures were performed, double-blind, crossover evaluations demonstrated that stimulation of the subthalamic nucleus was associated with a median improvement in the motor score (as compared with no stimulation) of 49 percent, and stimulation of the pars interna of the globus pallidus with a median improvement of 37 percent (P