Bilateral Subthalamic Deep Brain Stimulation in Parkinson Disease Patients With Severe Tremor
Bilateral Subthalamic Deep Brain Stimulation in Parkinson Disease Patients With Severe Tremor
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DOI：
10.1227/01.neu.0000374850.98949.d4
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发表时间：
2010-09
期刊：
影响因子：
4.8
通讯作者：
Han-Joon Kim;B. Jeon;S. Paek;Jee-Young Lee;Hee-Jin Kim;C. Kim;D. Kim
中科院分区：
文献类型：
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作者：
Han-Joon Kim;B. Jeon;S. Paek;Jee-Young Lee;Hee-Jin Kim;C. Kim;D. Kim
背景以前的研究表明，丘脑底核(STN)脑深部刺激(DBS)可以改善帕金森病(PD)患者的震颤。然而，这些研究中的患者没有根据震颤的严重程度进行选择。目的：我们专门评估了STN DBS对部分伴有严重震颤的帕金森病患者的震颤疗效。方法选择接受双侧STN DBS治疗的72例PD患者。在平均持续2年后，评估STN DBS对在基线水平被选为每个类别中最严重的三分之一的患者的非服药震颤、服药中震颤和非服药动作震颤的影响。结果停药后震颤严重的患者，停药后震颤评分从基线的12.28±2.80提高到最后一次随访时的1.93±2.85(P<；.001)。最后一次随访时，非刺激状态下的非用药震颤没有手术前非用药状态下的震颤严重。严重用药震颤患者用药后震颤评分由6.17±2.45提高到1.35±2.58(P<；.001)。严重停药后动作震颤患者的停药后动作震颤评分由5.08±1.35提高到1.24±1.42(P<；.001)。结论DBS对帕金森病患者严重的停药后和服药后震颤及停药后动作震颤均有效。我们的研究结果表明，STN DBS至少部分地通过影响独立于多巴胺能传递的震颤发生机制来减轻PD震颤，并且长期电刺激STN可能会引起结构或神经化学变化，从而导致震颤的改善。
BACKGROUNDPrevious studies have shown that subthalamic nucleus (STN) deep brain stimulation (DBS) improves tremor in Parkinson disease (PD). However, the patients included in those studies were unselected for tremor severity. OBJECTIVEWe specifically assessed the effect of STN DBS on tremor in selected PD patients with severe tremor. METHODSSeventy-two PD patients who had received bilateral STN DBS were included. The effects of STN DBS on the off-medication tremor, the on-medication tremor, and the off-medication action tremor in patients selected as the worst one-third in each category at baseline were evaluated after a mean duration of > 2 years. RESULTSIn patients with severe off-medication tremor, off-medication tremor score improved from 12.28 ± 2.80 at baseline to 1.93 ± 2.85 at the last follow-up (P < .001). The off-medication tremor in the off-stimulation state at the last follow-up was less severe than the preoperative off-medication tremor. In patients with severe on-medication tremor, on-medication tremor score improved from 6.17 ± 2.45 to 1.35 ± 2.58 (P < .001). In patients with severe off-medication action tremor, off-medication action tremor score improved from 5.08 ± 1.35 to 1.24 ± 1.42 (P < .001). CONCLUSIONSTN DBS is effective for severe off- and on-medication tremor and off-medication action tremor in PD. Our findings suggest that STN DBS reduces PD tremor through, at least in part, its effect on the tremor-generating mechanism independent of dopaminergic transmission and that long-term electrical stimulation of STN might induce a structural or neurochemical change leading to the improvement of tremor.