Subthalamic nucleus stimulation for Parkinson disease: benefits observed in levodopa-intolerant patients
Subthalamic nucleus stimulation for Parkinson disease: benefits observed in levodopa-intolerant patients
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DOI：
10.3171/jns.2001.95.2.0213
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发表时间：
2001-08-01
影响因子：
4.1
通讯作者：
Mizutani, T
中科院分区：
文献类型：
--
作者：
Katayama, Y;Kasai, M;Mizutani, T
Object.在左旋多巴不耐受的帕金森病（PD）患者中进行了丘脑底核（ENA）刺激效果的盲法评价。这些患者（第I组，7例患者）为中度或重度残疾（休药期间Hoehn和Yahr III-V期），但由于其出现难以忍受的副作用，仅接受小剂量药物治疗（左旋多巴等效剂量[LED] 0-400 mg/天）。结果进行了分析，与晚期PD患者（组If，7例患者）谁是严重残疾（Hoehn和Yahr阶段IV和V在关闭期间），但用大剂量的药物治疗（500-990毫克/天）。术后6 ~ 8个月对患者进行两次评估。为了确定脑电刺激对其整体日常活动的实际益处，患者以最佳剂量和时间表维持其药物治疗方案。关闭刺激过夜至少12小时。它在早上打开（或保持关闭），每个患者在清醒的白天活动期间的统一帕金森病评定量表上的最好和最差分数分别记录为开启和关闭期分数。随机决定是否进行刺激的评估顺序，刺激组患者的日常活动和总运动评分明显改善。在间歇性不动而未接受刺激的患者中，不动时间百分比（Hoehn和Yahr IV和V期）变为0%。震颤、僵硬、运动不能和步态分项评分得到改善。第二组患者的日常活动和总运动评分的改善不太明显，但仍然明显。在未接受刺激时显示间歇性不动伴明显运动波动的患者中，不动时间百分比以及LED减少。这些患者的震颤、僵硬和运动障碍分项评分均有所改善。相比之下，在对耐受剂量的左旋多巴无反应且持续不动的患者中，即使这些患者的震颤和僵硬分项评分仍通过刺激得到改善，但震颤刺激并没有改善患者的整体日常活动。与早期的发现一致，左旋多巴不耐受患者的多巴胺刺激的巨大益处是多巴胺刺激可以降低所需左旋多巴药物的水平。这表明，通过使左旋多巴药物维持在尽可能低的剂量，并防止继续使用大剂量左旋多巴的不良反应，多巴胺刺激可能是晚期PD患者的治疗选择。
Object. A blinded evaluation of the effects of subthalamic nucleus (STN) stimulation was performed in levodopa-intolerant patients with Parkinson disease (PD). These patients (Group I, seven patients) were moderately or severely disabled (Hoehn and Yahr Stages III-V during the off period), but were receiving only a small dose of medication (levodopa-equivalent dose [LED] 0-400 mg/day) because they suffered unbearable side effects. The results were analyzed in comparison with those obtained in patients with advanced PD (Group If, seven patients) who were severely disabled (Hoehn and Yahr Stages IV and V during the off period), but were treated with a large dose of medication (500-990 mg/day).Methods. The patients were evaluated twice at 6 to 8 months after surgery. To determine the actual benefits afforded by STN stimulation to their overall daily activities, the patients were maintained on their medication regimen with optimal doses and schedules. Stimulation was turned off overnight for at least 12 hours. It was turned on in the morning (or remained turned off), and each patient's best and worst scores on the Unified Parkinson's Disease Rating Scale during waking daytime activity were recorded as on- and off-period scores, respectively. The order of assessment with respect to whether stimulation was occurring was determined randomly.The STN stimulation markedly improved daily activity and total motor scores in Group I patients. The percentage time of immobility (Hoehn and Yahr Stages IV and V) became 0% in patients who were intermittently immobile while not receiving stimulation. Improvements were demonstrated in tremor, rigidity, akinesia, and gait subscores. The STN stimulation produced less marked but still noticeable improvements in the daily activity and total motor scores in Group II patients. The percentage time of immobility as well as the LED was reduced in patients who displayed intermittent immobility with pronounced motor fluctuations while not receiving stimulation. Improvements were demonstrated in tremor, rigidity, and dyskinesia subscores in these patients. In contrast, STN stimulation did not improve the overall daily activities at all in patients who had become unresponsive to a tolerable dose of levodopa and were continuously immobile, even though these patients' tremor and rigidity subscores were still improved by stimulation.Conclusions. Consistent with earlier findings, the great benefit of STN stimulation in levodopa-intolerant patients is that STN stimulation can reduce the level of required levodopa medication. This suggests that STN stimulation could be a therapeutic option for patients with less-advanced PD by allowing levodopa medication to be maintained at as low a dose as possible, and to prevent adverse reactions to the continued use of large-dose levodopa.