Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson's disease: Results of a randomized, blinded pilot study
Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson's disease: Results of a randomized, blinded pilot study
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DOI：
10.1097/00006123-199912000-00024
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发表时间：
1999-12-01
期刊：
影响因子：
4.8
通讯作者：
Hammerstad, JP
中科院分区：
文献类型：
--
作者：
Burchiel, KJ;Anderson, VC;Hammerstad, JP
目的：苍白球内侧核(GPI)和丘脑底核(STN)脑深部电刺激(DBS)是缓解晚期帕金森病(PD)症状的有效方法。虽然最近的研究表明，STN刺激可能优于GPI刺激，但尚未有随机、盲法比较的报道。本研究旨在提供两个部位DBS的安全性和有效性的初步比较。方法：10例特发性帕金森病患者，L-多巴诱导的运动障碍，反应波动，随机植入双侧GPI或STN刺激器。分别于植入后10天、3个月、6个月、12个月用L多巴和DBS对患者的神经功能进行评估。在整个研究期间，患者和评估临床医生对刺激部位都是盲目的。结果：停用L多巴后，两组患者表现出相似的反应，在接受DBS治疗12个月后，统一PD评定量表运动评分提高了约40%。两组僵硬、震颤和运动迟缓均有改善。与L-多巴评分相结合，GPI刺激对统一PD评定量表运动评分的改善优于STN刺激。胃肠炎组的轴性症状明显改善，而短暂性肾炎组则无明显改善。DBS可减少L-多巴诱发的运动障碍，但仅在STN组减少用药。两组患者均未发生严重的术中并发症。结论：帕里达尔联合STN刺激治疗晚期帕金森病安全有效。需要进行更大规模的研究，以进一步调查症状反应的差异以及L-多巴与刺激的相互作用。
OBJECTIVE: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) and subthalamic nucleus (STN) has been reported to be effective in alleviating the symptoms of advanced Parkinson's disease (PD). Although recent studies suggest that STN stimulation may be superior to GPi stimulation, a randomized, blinded comparison has not been reported. The present study was designed to provide a preliminary comparison of the safety and efficacy of DBS at either site.METHODS: Ten patients with idiopathic PD, L-dopa-induced dyskinesia, and response fluctuations were randomized to implantation of bilateral GPi or STN stimulators. Neurological condition was assessed preoperatively with patients on and off L-dopa and on DBS at 10 days and 3, 6, and 12 months after implantation. Patients and evaluating clinicians were blinded to stimulation site throughout the study period. Complete follow-up data were analyzed for four GPi patients and five STN patients.RESULTS: When off-L-dopa, both GPi and STN groups demonstrated a similar response, with approximately 40% improvement in Unified PD Rating Scale motor scores after 12 months of DBS. Rigidity, tremor, and bradykinesia improved in both groups. In combination with L-dopa, Unified PD Rating Scale motor scores were more improved by GPi stimulation than by STN stimulation. On-L-dopa axial symptoms were clinically improved in the GPi but not the STN group. L-Dopa-induced dyskinesia was reduced by DBS at either site, although medication requirement was reduced only in the STN group. There were no serious intraoperative complications among patients in either group.CONCLUSION: Pallidal and STN stimulation appears to be safe and efficacious for the management of advanced PD. A larger study is needed to investigate further the differences in symptom response and the interaction of L-dopa with stimulation at either site.