Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson's disease.

摘要: Objective: To reduce antiparkinsonian medication in parkinsonian patients with bilateral high frequency subthalamic nucleus (STN) stimulation. Background: Parkinsonian syndromes are characterized by hyperactivity of the STN. Preliminary data indicate that functional inactivation STN may requirement for dopaminergic therapy PD. Methods: Bilateral quadripolar leads were implanted stereotactically seven advanced PD (mean age, 57.4 years; mean disease duration, 15.4 years). High-frequency stimulation was applied 24 hours a day. Following implantation, reduced to minimum possible and gradually increased. The evaluated practically defined “off” “on” conditions using Unified Parkinson’s Disease Rating Scale (UPDRS) Schwab & England scale. average follow-up 16.3 ± 7.6 months. A battery neuropsychological tests before 9 months after implant. Results: features improved all patients—the greatest change seen rigidity, then tremor, followed bradykinesia. Compared presurgical condition, off-drug UPDRS motor scores 41.9% on last visit ( p = 0.0002), activities daily living (ADL) 52.2% scale score 213% 0.0002). levodopa-equivalent dose 65%. Night sleep due increased mobility at night, five insomnia resolved. All gained weight surgery their appetite gain 13% compared surgery. During visit, amplitude 2.9 0.5 V total energy delivered per patient averaged 2.7 1.4 W × 10 −6 . results self-assessment scales indicated marked improvement moderate other two. showed no changes. Side effects mild tolerable. In cases, tradeoff between optimal voltage severity side made it control signs effectively. most directly related consisted ballistic or choreic dyskinesias neck limbs elicited contralateral above given threshold voltage, which varied depending individual. Conclusions: can be controlled high-frequency procedure is well tolerated. On-state greatly reduced, probably reduction medication. compensated drug dyskinesias, differ from those observed following ADL significantly, suggesting some tasks performed during everyday chores, not taken into account score, also improved.