Deep-Brain Stimulation for Parkinson's Disease
Deep-Brain Stimulation for Parkinson's Disease
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DOI：
10.1056/nejmct1208070
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发表时间：
2012-10-18
影响因子：
158.5
通讯作者：
Okun, Michael S.
中科院分区：
文献类型：
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作者：
Okun, Michael S.
一名 72 岁的右撇子，有 12 年帕金森病病史，表现为对药物反应减弱和右侧运动障碍（不自主运动）。在过去的几年里，他一直在服用多种治疗帕金森病的药物，包括单胺氧化酶抑制剂、金刚烷胺、多巴胺激动剂和卡比多巴-左旋多巴。他报告说，按照目前的治疗方案，包括每 2 小时服用 1.5 片 25/100 卡比多巴-左旋多巴，他的震颤、僵硬和运动迟缓明显减轻，行走能力也得到显着改善。然而，尽管进行了多次间隔和剂量调整，他仍然报告每天有 6 小时的“休息”时间，此时他的症状对他当前的药物治疗方案没有反应。此外，他还患有每天 4 小时的严重右侧运动障碍。影响他左侧身体的症状很轻微，并不令人烦恼。他的认知能力非常好，神经系统检查其他方面均正常，并且没有其他共存疾病。他的神经科医生建议他去看神经外科医生，考虑进行深部脑刺激。
A 72-year-old right-handed man with a 12-year history of Parkinson's disease presents with a diminished response to medication and right-sided dyskinesia (involuntary movements). During the past several years, he has been taking multiple drugs for Parkinson's disease, including a monoamine oxidase inhibitor, amantadine, a dopamine agonist, and carbidopa-levodopa. He reports that with his current regimen, which includes 1.5 tablets of 25/100 carbidopa-levodopa taken every 2 hours, he has marked reductions in tremor, rigidity, and bradykinesia and substantial improvement in his walking. Despite multiple interval and dose adjustments, however, he also reports 6 hours per day of "off" time, when his symptoms are unresponsive to his current medication regimen. In addition, he has severe, disabling right-sided dyskinesia 4 hours per day. Symptoms affecting his left side are mild and not bothersome. His cognition is excellent, his neurologic examination is otherwise normal, and he has no other coexisting medical conditions. His neurologist refers him to a neurosurgeon for consideration of deep-brain stimulation.