Objective monitoring of tremor and bradykinesia during DBS surgery for Parkinson disease
Objective monitoring of tremor and bradykinesia during DBS surgery for Parkinson disease
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DOI：
10.1212/01.wnl.0000308936.27780.94
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发表时间：
2008-04-08
期刊：
影响因子：
9.9
通讯作者：
Gallo, B. V.
中科院分区：
文献类型：
--
作者：
Papapetropoulos, S.;Jagid, J. R.;Gallo, B. V.
目的：高频丘脑底核深部脑刺激（STN-DBS）是晚期帕金森病（PD）患者的既定治疗方法。迄今为止，帕金森症状（例如震颤和运动迟缓）的术中监测主要基于主观策略。我们进行了一项试点研究，使用神经运动症状登记装置（CATSYS 2000 系统）评估 PD 患者单侧 STN-DBS 宏观刺激的短期术中结果。方法：我们使用带有两个传感器（震颤笔和触摸记录板）的简单便携式系统，研究了 12 名接受分期单侧 STN-DBS 植入的连续 PD 患者和 10 名无神经功能缺损的男性对照受试者。结果显示，姿势性震颤具有出色的重测可靠性。在控制对象中。 PD患者在术前“关闭”状态下和术中进行休息、姿势性震颤强度和手指敲击频率的评估。使用重复测量的方差分析对宏观刺激前和宏观刺激后进行比较。结果：电子静止震颤记录显示，受刺激侧/对侧震颤强度测量值平均提高了 12.5 倍 (p = 0.002)。未受刺激/同侧的整体改善为 x3.8。 STN-DBS 后姿势性震颤和手指敲击频率也有显着改善。结论：使用无创、简单、灵敏的电子记录方法记录术中运动症状，我们能够通过客观量化对丘脑深部宏观刺激反应的震颤和手指敲击特征来补充短期临床观察。
Objective: High-frequency subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for patients with advanced Parkinson disease (PD). To date, intraoperative monitoring of parkinsonian symptoms, such as tremor and bradykinesia, is largely based on subjective strategies. We conducted a pilot study to evaluate short-term intraoperative outcomes of unilateral macrostimulation of the STN-DBS in PD patients using a neuromotor symptom registration device (CATSYS 2000 System).Methods: We studied 12 consecutive PD patients who received staged unilateral STN-DBS implants and 10 male control subjects free of neurologic deficits using a simple portable system with two sensors: a tremor pen and a touch recording plate.Results revealed excellent test-retest reliability for postural tremor in control subjects. PD patients were evaluated preoperatively during "off" state and intraoperatively for rest, postural tremor intensity, and frequency of finger tapping. Comparisons between premacrostimulation and postmacrostimulation were made using analysis of variance for repeated measures. Results: Electronic rest tremor registration revealed a mean improvement of x12.5 in tremor intensity measurements in the stimulated/contralateral side (p = 0.002). An overall x3.8 improvement was registered on the nonstimulated/ipsilateral side. Significant improvements after STN-DBS were also recorded for postural tremor and frequency of finger tapping.Conclusion: Using a noninvasive, simple, and sensitive electronic recording method of intraoperative motor symptom registration, we were able to supplement short-term clinical observation by objectively quantifying the characteristics of tremor and finger tapping in response to subthalamic nucleus deep brain macrostimulation.