Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease
Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease
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DOI：
10.1093/brain/awl346
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发表时间：
2007-06-01
期刊：
影响因子：
14.5
通讯作者：
Mazzone, Paolo
中科院分区：
文献类型：
--
作者：
Stefani, Alessandro;Lozano, Andres M.;Mazzone, Paolo
步态障碍和运动不能对晚期帕金森病患者来说是极其严重的。有人建议，调节桥脚核（PPN）的活性可能有益于治疗这些症状。我们报告了深部脑刺激 (DBS) 对 PPN 和丘脑底核 (STN) 的临床影响。 6 名对步态和姿势稳定性等轴向体征药物控制不理想的患者接受了 STN 和 PPN 的双侧 DBS 电极植入。手术后 2-6 个月在关闭和开启药物状态下评估临床效果，STN 和 PPN 刺激均开启或关闭，或仅刺激一个目标。停药时，25 Hz 的双侧 PPN-DBS 使运动统一帕金森病评定量表 (UPDRS) 子量表评分立即改善 45%，随后下降，3-6 个月后评分最终改善 32%。相比之下，130-185 Hz 的双边 STN-DBS 带来约 54% 的改善。 PPN-DBS 对步态和姿势项目特别有效。在用药状态下，与激活任一单一靶点介导的特定益处相比，STN 和 PPN-DBS 的联合提供了显着的进一步改善。此外，两个目标的联合 DBS 促进了日常生活活动表现的显着改善。这些发现表明，在晚期帕金森病患者中，PPN-DBS 与标准 STN-DBS 相关可能有助于改善步态和优化多巴胺介导的 ON 状态，特别是对于那些对仅 STN DBS 的反应随着时间的推移而恶化的患者。这种靶点组合也可能对锥体外系疾病有用，例如进行性核上性麻痹，目前这种疾病的治疗方法还难以捉摸。
Gait disturbances and akinesia are extremely disabling in advanced Parkinson's disease. It has been suggested that modulation of the activity of the pedunculopontine nucleus (PPN) may be beneficial in the treatment of these symptoms. We report the clinical affects of deep brain stimulation (DBS) in the PPN and subthalamic nucleus (STN). Six patients with unsatisfactory pharmacological control of axial signs such as gait and postural stability underwent bilateral implantation of DBS electrodes in the STN and PPN. Clinical effects were evaluated 2-6 months after surgery in the OFF- and ON-medication state, with both STN and PPN stimulation ON or OFF, or with only one target being stimulated. Bilateral PPN-DBS at 25 Hz in OFF-medication produced an immediate 45% amelioration of the motor Unified Parkinson's Disease Rating Scale (UPDRS) subscale score, followed by a decline to give a final improvement of 32% in the score after 3-6 months. In contrast, bilateral STN-DBS at 130-185 Hz led to about 54% improvement. PPN-DBS was particularly effective on gait and postural items. In ON-medication state, the association of STN and PPN-DBS provided a significant further improvement when compared to the specific benefit mediated by the activation of either single target. Moreover, the combined DBS of both targets promoted a substantial amelioration in the performance of daily living activities. These findings indicate that, in patients with advanced Parkinson's disease, PPN-DBS associated with standard STN-DBS may be useful in improving gait and in optimizing the dopamine-mediated ON-state, particularly in those whose response to STN only DBS has deteriorated over time. This combination of targets may also prove useful in extra-pyramidal disorders, such as progressive supranuclear palsy, for which treatments are currently elusive.