Therapeutic effect and strategy of deep brain stimulation on Parkinson's disease after pallidum or thalamus lesion

Abstract

Objective To investigate the feasibility and efficacy of deep brain stimulation (DBS) in the treatment of Parkinson's disease (PD) after pallidum or thalamus lesion, and to analyze its therapeutic strategy. Methods From December 2013 to December 2019, nine patients with PD whose symptoms recurred after nuclear lesion and underwent DBS were selected. MRI combined with microelectrode recording (MER) technology was used to locate the target, and patients were treated with DBS. The adverse events during and after awake anesthesia and postoperative follow⁃up were observed to evaluate the safety of operation, Unified Parkinson's Disease Rating Scale (UPDRS) and Activities of Daily Living Scale (ADL) were used to evaluate the improvement of postoperative symptoms and the efficacy of DBS. Results In this group of 9 patients, 2 patients were treated with unilateral subthalamic nucleus (STN) ⁃ DBS, the remaining 7 cases were treated with bilateral STN ⁃ DBS; the cell discharge frequency recorded on the ipsilateral and contralateral sides of the lesion was 400-500 Hz, without significant difference. There were no intraoperative and postoperative complications, and the symptoms of all patients were improved in varying degrees. After 3 months of stimulation, the UPDRS score of PD patients decreased from (115.56 ± 26.17) score to (32.56 ± 9.08) score, the difference was statistically significant (t = 10.853, P = 0.000); and the ADL score increased from (38.56 ± 6.09) score to (73.68 ± 19.07) score, the difference was statistically significant (t = 10.850, P = 0.000). There was no postoperative complication. Conclusions For PD patients who had undergone unilateral pallidotomy or thalamus lesion, if limb stiffness/tremor symptoms exist, as long as the STN nuclei have complete anatomical structure, selective STN⁃DBS assisted by MER is safe and feasible, and bilateral STN⁃DBS would be better.

DOI：10.3969/j.issn.1672⁃6731.2020.12.004