Direct effect of subthalamic nucleus stimulation on levodopa-induced peak-dose dyskinesia in patients with Parkinson's disease
Direct effect of subthalamic nucleus stimulation on levodopa-induced peak-dose dyskinesia in patients with Parkinson's disease
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DOI：
10.1159/000094957
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发表时间：
2006-01-01
影响因子：
1.7
通讯作者：
Yamamoto, Takamitsu
中科院分区：
文献类型：
--
作者：
Katayama, Yoichi;Oshima, Hideki;Yamamoto, Takamitsu
我们研究了丘脑底核脑深部电刺激（STN-DBS）对45例帕金森病（PD）患者左旋多巴诱导的峰值剂量运动障碍的直接影响，术后早期未减少左旋多巴剂量。在8名患者（18%）中，在实验性试验（5分钟）中，通过双极刺激快速减弱了运动障碍，接触点放置在小脑上的区域内。相比之下，双极刺激使用的接触放置在脊髓本身往往会引发或加剧运动障碍，这表明运动障碍可以通过刺激脊髓上方的区域而不是脊髓本身来抑制。为了同时控制PD和运动障碍的主要症状，我们采用了具有较长极间距离的双极刺激作为治疗程序（2周），使用延髓内的触点作为阴极，延髓上方区域内的触点作为阳极。双侧STN-DBS显著减轻了运动障碍，如运动障碍严重程度评定量表所评估的（p < 0.05）。在24例患者（53%）中，观察到运动障碍几乎完全控制。与其他患者相比，这些患者用作阳极的触点位于背侧，再次表明运动障碍是通过刺激小脑上的区域而不是小脑本身来抑制的。在丘脑上区，苍白球丘脑、苍白球下丘脑和下丘脑-苍白球纤维密集分布。似乎刺激这些纤维可能会引起类似于丘脑或苍白球DBS的效应，因此抑制峰值剂量运动障碍。双极STN-DBS的触点放置在小脑上的区域内作为阳极，似乎是同时控制PD和峰值剂量运动障碍的主要症状的有用选择。版权所有（c）2006 S. Karger AG，巴塞尔
We examined the direct effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on levodopa-induced peak-dose dyskinesia in 45 patients with Parkinson's disease (PD) without reducing the levodopa dosage during the early period after surgery. In 8 patients (18%), the dyskinesia was quickly attenuated by bipolar stimulation in an experimental trial (5 min) with the contacts placed within the area above the STN. In contrast, bipolar stimulation using contacts placed within the STN itself tended to provoke or exacerbate the dyskinesia, indicating that dyskinesia could be inhibited by stimulation of the areas above the STN rather than the STN itself. In an attempt to control the cardinal symptoms of PD and dyskinesia at the same time, we employed bipolar stimulation with a longer interpolar distance as a therapeutic procedure (2 weeks), using contacts within the STN as a cathode and contacts within the area above the STN as an anode. Bilateral STN-DBS significantly attenuated the dyskinesia as evaluated by the dyskinesia severity rating scale (p < 0.05). In 24 patients (53%), almost complete control of the dyskinesia was observed. The contacts used as an anode in these patients were located more dorsally compared to those of the remaining patients, suggesting again that the dyskinesia was inhibited by stimulation of the areas above the STN rather than the STN itself. In the area above the STN, pallidothalamic, pallidosubthalamic and subthal-amopallidal fibers are densely distributed. It appears that stimulation of these fibers may cause effects similar to thalamic or pallidal DBS and therefore inhibit peak-dose dyskinesia. Bipolar STN-DBS with contacts placed within the area above the STN as an anode appears to represent a useful option for controlling both the cardinal symptoms of PD and peak-dose dyskinesia at the same time. Copyright (c) 2006 S. Karger AG, Basel