DEEP BRAIN STIMULATION FOR THE TREATMENT OF INVOLUNTARY MOVEMENT DISORDERS

我们研究了慢性深部脑刺激治疗不自主运动障碍的效果，并总结了白球（Gpi; n = 7）和丘脑下核（STN; n = 11）刺激对晚期帕金森病患者疗效的双盲评价结果。术后6-8个月对患者进行评估。为了确定刺激对实际日常活动的益处，患者保持最佳剂量和时间表的药物治疗。刺激在夜间至少关闭12小时。它在早上打开（或保持关闭状态），白天活动时的最佳和最差分数分别被记录为开启期和关闭期分数。Gpi和STN刺激在非活动期（分别为-57%和-29%）和活动期（分别为-36%和-25%）均明显引起统一帕金森病评定量表（Unified Parkinson's Disease Rating Scale）的总运动评分降低。Gpi和STN刺激之间的效果差异似乎主要是由于患者术前症状的意外差异。对于对大剂量左旋多巴无反应的患者，刺激对实际日常活动的益处似乎有限。确定了Gpi和STN刺激的两个优点。这种刺激可以在非经期补充左旋多巴的减弱作用。其次，刺激可以部分替代左旋多巴的作用。更重要的是，这种刺激改善了多巴不耐受患者的日常活动，这些患者因为难以忍受的副作用而服用小剂量的左旋多巴。

We studied about the effects of chronic deep brain stimulation for the treatment of involuntary movement disorders, and the results of a double blinded evaluation of the effects of globus pallidus (Gpi; n = 7) and subthalamic nucleus (STN; n = 11) stimulation in patients with advanced Parkinson's disease are summarized in this report. The patients were evaluated at 6-8 months after surgery. In order to determine the benefits afforded by the stimulation to the actual daily activities, the patients were maintained on-medication with optimal doses and schedules. The stimulation was turned off overnight for at least 12 hours. It was turned on in the morning (or maintained turned off), and the best and worst scores during daytime actibity were recorded, as on-period and off-period scores, respectively. A reduction in total motor score on the Unified Parkinson's Disease Rating Scale was clearly elicited by Gpi and STN stimulation at both the off-period (-57% and -29%, respectively) and the on-period (-36% and -25%, respectively). The difference in effects between Gpi and STN stimulation appeared to be due largely to an unintended difference in the patients preoperative symptoms. The benefits provided by stimulation to the actual daily activities appears to be limited in patients who have become unresponsive to a large dose of levodopa. Two advantages of Gpi and STN stimulation were identified. The stimulation can supplement a reduced action of levodopa during the off-period. Secondary, the stimulation can replace part of the action of levodopa during the on-period. More importantly, the stimulation improves the daily activities in dopa-intolerant patients who are being administered a small dose of levodopa because of unbearable side effects.