Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation
Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation
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DOI：
10.1136/jnnp.68.5.595
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发表时间：
2000-05-01
影响因子：
11
通讯作者：
Agid, Y
中科院分区：
文献类型：
--
作者：
Bejjani, BP;Gervais, D;Agid, Y
目的探讨高频电刺激丘脑底核（subthalamic nucleus，HRF）对晚期帕金森病（Parkinson's disease，PD）患者轴性症状的影响。然后分别研究了肢体运动不能、僵硬和震颤（已知对左旋多巴有反应）和轴向体征（包括言语、颈部僵硬、从椅子上站起来、姿势、步态和姿势稳定性）的分项评分，已知对左旋多巴的反应较差。在手术植入刺激电极之前进行左旋多巴激发试验期间，对患者的“关闭”和“开启”药物条件进行临床评估，并在手术后6个月在连续电刺激下重复进行。从每位患者的问卷中获得来自“日常生活活动”（ADL）的轴性症状的补充评分-即言语，吞咽，床上翻身，跌倒，行走和冻结结果：运动功能障碍总评分（62%）、肢体体征（62%）、在术前激发期间，用电刺激获得的轴向体征（72%）与用左旋多巴获得的体征在统计学上相当（分别为68%、69%和59%），与术前给予左旋多巴相比，当左旋多巴和电刺激联合使用时，总运动障碍进一步改善（80%）。这主要包括轴向体征（84%）的额外改善，主要是姿势和姿势稳定性，没有发现左旋多巴反应体征的进一步改善。当左旋多巴和多巴胺刺激联合使用时，ADL的轴性症状显示出类似的额外改善。结论-这些发现表明，双侧丘脑刺激改善了帕金森病的大多数轴向特征，并且可以获得协同效应当刺激与左旋多巴治疗结合使用时。
Objective-To assess the effects of high frequency stimulation of the subthalamic nucleus (STN) on axial symptoms occurring in advanced stages of Parkinson's disease (PD).Methods-The efficacy of STN stimulation on total motor disability score (unified Parkinson's disease rating scale (UPDRS) part III) were evaluated in 10 patients with severe Parkinson's disease. The subscores were then studied separately for Limb akinesia, rigidity, and tremor, which are known to respond to levodopa, and axial signs, including speech, neck rigidity, rising from a chair, posture, gait, and postural stability, which are known to respond less well to levodopa. Patients were clinically assessed in the "off" and "on" drug condition during a levodopa challenge test performed before surgical implantation of stimulation electrodes and repeated 6 months after surgery under continuous STN stimulation. A complementary score for axial symptoms from the "activities of daily living" (ADL)-that is, speech, swallowing, turning in bed, falling, walking, and freezing-was obtained from each patient's questionnaire (UPDRS, part II).Results-Improvements in total motor disability score (62%), limb signs (62%), and axial signs (72%) obtained with STN stimulation were statistically comparable with those obtained with levodopa during the preoperative challenge (68%, 69%, and 59%, respectively), When levodopa and STN stimulation were combined there was a further improvement in total motor disability (80%) compared with preoperative levodopa administration. This consisted largely of an additional improvement in axial signs (84%) mainly for posture and postural stability, no further improvement in levodopa responsive signs being found. Axial symptoms from the ADL showed similar additional improvement when levodopa and STN stimulation were combined.Conclusion-These findings suggest that bilateral STN stimulation improves most axial features of Parkinson's disease and that a synergistic effect can be obtained when stimulation is used in conjunction with levodopa treatment.