Outcomes from stimulation of the caudal zona incerta and pedunculopontine nucleus in patients with Parkinson's disease
Outcomes from stimulation of the caudal zona incerta and pedunculopontine nucleus in patients with Parkinson's disease
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DOI：
10.3109/02688697.2010.544790
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发表时间：
2011-04-01
影响因子：
1.1
通讯作者：
Gill, Steven S.
中科院分区：
文献类型：
--
作者：
Khan, Sadaquate;Mooney, Lucy;Gill, Steven S.
导论.轴性症状包括姿势不稳、福尔斯和步态启动失败，是帕金森病（PD）最主要的致残性运动症状。我们进行了双侧脑深部电刺激（DBS）的脚桥核（PPN）与尾侧三叉神经节（cZi）的组合，以确定其在减轻这些神经元的疗效。7例在“开”和“关”药物状态下均具有主要轴性症状的患者接受了双侧cZi和PPN DBS。使用统一帕金森氏病评定量表（UNITED Parkinson's Disease Rating Scale，简称DMRS 3）的运动部分评估运动结果，并从项目27、28、29和30（由椅子、姿势、步态和姿势稳定性引起）得出复合轴向分项评分。使用PDQ39测量生活质量。将基线时获得的评分与平均随访12个月时获得的评分进行比较。结果。在停药和给药状态下，通过刺激PPN、cZi和两者的组合，实现了PPN RS第3部分评分的统计学显著改善。在停药状态下，PPN、cZi和两者联合刺激后，我们的PPN RS第3部分的复合轴向分项评分改善。然而，在“开启”药物状态下，复合轴向分项评分仅在cZi和PPN刺激联合使用时显示出统计学显著改善。这项研究提供的证据表明，PPN和cZi刺激的组合可以实现迄今为止无法治疗的PD的药物治疗轴向症状的显着改善。
Introduction. Axial symptoms including postural instability, falls and failure of gait initiation are some of the most disabling motor symptoms of Parkinson's disease (PD). We performed bilateral deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) in combination with the caudal zona incerta (cZi) in order to determine their efficacy in alleviating these symptoms.Methods. Seven patients with predominant axial symptoms in both the 'on' and 'off' medication states underwent bilateral cZi and PPN DBS. Motor outcomes were assessed using the motor component of the Unified Parkinson's Disease Rating Scale (UPDRS 3) and a composite axial subscore was derived from items 27, 28, 29 and 30 (arising from chair, posture, gait and postural stability). Quality of life was measured using the PDQ39. Comparisons were made between scores obtained at baseline and those at a mean follow-up of 12 months.Results. In both the off and on medication states, a statistically significant improvement in the UPDRS part 3 score was achieved by stimulation of the PPN, cZi and both in combination. In the off medication state, our composite axial subscore of the UPDRS part 3 improved with stimulation of the PPN, cZi and both in combination. The composite axial subscore, in the 'on' medication state, however, only showed a statistically significant improvement when a combination of cZi and PPN stimulation was used.Conclusions. This study provides evidence that a combination of PPN and cZi stimulation can achieve a significant improvement in the hitherto untreatable 'on' medication axial symptoms of PD.