■深部脑刺激(DBS)是一种针对双侧丘脑下核或苍白球(STN或GPi-DBS)的晚期帕金森病(PD)的有效治疗方法。到目前为止,关于单侧STN-DBS对运动症状的疗效的详细研究已有报道,但很少有关于单侧GPi-DBS的研究。
■选择17名接受单侧GPi-DBS的帕金森病(PwPD)患者。我们使用以下测量工具对术前和术后6-42个月获得的分数进行了比较分析:运动障碍协会统一帕金森病评定量表(MDS-UPDRS)第三部分,Hoehn和Yahr的舞台,运动障碍的存在/不存在,小型精神状态检查(MMSE),正面评估电池(FAB),老年抑郁量表(GDS),左旋多巴等效剂量(LED),通过单光子发射计算机断层扫描(SPECT)和脑血流。在四个具有良好反应者的队列之间比较了患者背景(良好反应者,改善≥50%)和不利(反应不佳,<50%改善)术后转归。
■术后观察到以下方面的显着改善:停运期间的MDS-UPDRS第三部分总分,对侧得分,同侧分数,和轴向得分。同样,休战期间的Hoehn和Yahr阶段,GDS也表现出显著下降。相比之下,LED,MMSE,和FAB保持不变,而运动障碍得分为阳性的患者人数减少了40%。术前在大脑皮层中观察到的异常脑血流量在基于总得分的良好反应者队列中已正常化。在基于同侧评分的良好反应者队列中,脑血流量在对侧额叶增加,包括运动前皮层,对侧DBS。与可怜的响应者相比,术后反应良好者显示术前MMSE评分显著较高.
■单侧GPi-DBS治疗可有效改善对侧,同侧,和晚期PD患者的轴向运动症状;特别是,发现这对认知功能未受损的PwPD特别有益;直到术后至少6个月,治疗效果与双侧同行相当。最后,术前脑血流异常的正常化和对侧额叶脑血流的增加表明该疗法对同侧运动症状的有益潜力。
UNASSIGNED: Deep brain stimulation (DBS) is an effective treatment for advanced Parkinson\'s disease (PD) with the targeting bilateral subthalamic nucleus or globus pallidus internus (STN or GPi-DBS). So far, detailed studies on the efficacy of unilateral STN-DBS for motor symptoms have been reported, but few studies have been conducted on unilateral GPi-DBS.
UNASSIGNED: Seventeen patients with Parkinson\'s disease (PwPD) who underwent unilateral GPi-DBS were selected. We conducted comparison analyses between scores obtained 6-42 months pre- and postoperatively using the following measurement tools: the Movement Disorder Society Unified Parkinson\'s Disease Rating Scale (MDS-UPDRS) part III, the Hoehn and Yahr stage, the presence/absence of dyskinesia, Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Geriatric Depression Scale (GDS), levodopa equivalent dose (LED), and cerebral blood flow by single photon emission computed tomography (SPECT). Patient backgrounds were compared between four cohorts with favorable (good responders, ≥50% improvement) and unfavorable (poor responders, <50% improvement) postoperative outcome.
UNASSIGNED: Significant improvement was observed postoperatively in the following: total MDS-UPDRS Part III scores during the off period, contralateral scores,
ipsilateral scores, and axial scores. Similarly, the Hoehn and Yahr stages during the off period, and GDS also showed significant decrease. In contrast, LED, MMSE, and FAB remained unchanged while the number of patients who scored positive for dyskinesia decreased by 40%. Abnormal cerebral blood flow preoperatively seen in the cerebral cortex had normalized in the total score-based good responder cohort. In the
ipsilateral score-based good responder cohort, cerebral blood flow increased in the contralateral frontal lobe including in the premotor cortex, contralateral to the DBS. Compared to the poor responders, postoperative good responders demonstrated significantly higher preoperative MMSE scores.
UNASSIGNED: Unilateral GPi-DBS therapy was effective in improving contralateral,
ipsilateral, and axial motor symptoms of patients with advanced PD; in particular, it was found to be especially beneficial in PwPD whose cognitive function was unimpaired; the treatment efficacy rivaled that of bilateral counterparts up till at least 6 months postoperatively. Finally, normalization of preoperative abnormalities in cerebral blood flow and increased cerebral blood flow in the contralateral frontal lobe indicated the beneficial potential of this therapy on
ipsilateral motor symptoms.