丘脑底核与电刺激术效果关系的研究

目的 研究脑深部电刺激（DBS）对帕金森病（PD）的治疗作用，观察术中丘脑底核（STN）刺激对PD震颤、肌僵直、运动的缓解效果以及对语言的影响，探讨电极在丘脑底核内的解剖位置与刺激效果的关系，以寻找植入刺激电极至STN的最佳位置。方法 26例帕金森病患者，利用MRI及微电极导向立体定向方法将刺激电极植入丘脑底核，其靶点：X＝11mm-13mm,Y=-1mm--3mm,Z=-7mm。术中予以高频刺激（频率为130Hz－150Hz，脉宽为90μs-150μs，电压自0.5V开始，逐渐增至8V）；利用电极的不同触点分别进行刺激，根据刺激效果和副反应的出现情况，确定电极在STN中的最佳位置。其中有3例进行了STN电极永久性植入，术后随访6－14月。结果 26例术中刺激发现，STN背外侧部是电刺激的最佳位置，而电极过深及过外铡易引起言语障碍。结论 STN的高频刺激能改善PD的震颤、僵直、运动缓慢等主要症状，是PD慢性刺激的最理想靶点，其背外侧部是刺激效果的最佳位置。     

脑深部刺激电极重建临床应用的可靠性研究

目的基于临床常用的手术计划系统进行脑深部刺激电极三维重建,评估该项技术临床应用的可行性。方法回顾性纳入2017-01—12接受双侧丘脑底核(STN)DBS治疗的帕金森病患者21例,基于脑深部电极三维重建技术,根据植入电极与STN的位置关系,将病例分为2组(组1:双侧电极位于STN内;组2:一侧或双侧电极均不位于STN内)。分析基于电极重建技术与标准开机程控两种方式筛选的最佳刺激触点二者的吻合度,比较两种不同电极植入精确度对该吻合度的影响,并进一步分析两种筛选方式的最佳触点几何中心的空间坐标的差异。结果基于重建电极与标准开机流程两种方式筛选的最佳触点的吻合度达83.33%(35/42),左右两侧的吻合度差异无统计学意义,组1的最佳触点吻合度高于组2(88.24%vs 62.50%),但差异无统计学意义,两种方式筛选的最佳触点的空间坐标值差异也无统计学意义。结论脑深部电极重建技术能够立体直观呈现颅内电极与DBS目标核团的空间位置关系,基于该方式筛选的最佳刺激触点与传统开机程控方式存在较高的吻合度,该项技术可能有助于提高术后程控最佳DBS触点筛选的准确性与效率。     

丘脑底核脑深部电刺激术治疗高龄帕金森病

目的 总结高龄(>75岁)帕金森病(Parkinson's disease,PD)脑深部电刺激术(deep brain stimulation,DBS)的临床疗效.方法 回顾性分析18例高龄PD病例资料,均行丘脑底核(subthalamic nucleus,STN)-DBS,且双侧STN均植入电极.结果 平均手术时间(...     

脑深部电刺激猴帕金森病模型的建立

目的通过猴偏侧帕金森病（Parkinson disease,PD）模型丘脑底核（subthalamic nucleus,STN）脑深部电刺激（deep brain stimulation,DBS）系统的植入,对脑深部电刺激动物模型的制备进行了探讨.方法2只猴偏侧PD模型,按照猴脑立体定向图谱,在右侧STN植入脑深部刺激电极,并同期皮下植入脉冲发生器.术后行头颅X线平片和MRI检查,给予慢性高频电刺激,观察运动症状改善.结果2只偏侧猴PD模型成功的同期植入DBS系统,术后的症状观察和阿朴吗啡（apomorphine,APO）诱发旋转实验,证实STN慢性高频电刺激有效地缓解了猴PD样症状.结论通过立体定向技术同期将DBS系统植入动物体内,可以有效的建立DBS动物模型,为DBS在神经疾病的应用研究提供了良好的实验模型.     

帕金森病患者丘脑底核电极植入术中位置判断和调整

目的探讨帕金森病患者脑深部刺激术（DBS）中丘脑底核（STN）电极植入位置准确性判断和调整。方法对137例帕金森病（PD）患者进行了丘脑底核DBS治疗,其中单侧68例,双侧69例。采用磁共振扫描,图像直接定位和坐标值定位相结合的方法计算靶点坐标,微电极记录细胞外放电。术中采用微毁损效应,观察刺激效果和副作用,X线透视和带立体定向头架MRI复查。结果绝大部分患者都能观察到电极植入的微毁损效应、电刺激效果和刺激副作用,术中X线透视和带立体定向头架MRI复查能观察到电极实际位置,并进行必要的调整。结论通过微毁损效应、电刺激效果和刺激副作用观察以及术中影像学检查能及时纠正电极位置偏差,减少二次手术,从而提高PD患者的DBS疗效。     

全麻下机器人辅助脑深部电刺激术治疗帕金森病

目的 研究全麻下机器人辅助脑深部电刺激术(deep brain stimulation,DBS)治疗帕金森病(Parkinson's disease,PD)的疗效.方法 回顾性分析87例PD病例资料,均采用全麻下机器辅助DBS植入电极,并进行刺激参数调试.靶点选择丘脑底核(subthalamic nucleus,STN...     

脑深部电刺激术后首次精准程控的临床应用

目的 总结根据脑深部电刺激术(deep brain stimulation,DBS)电极植入位置和术中电生理信号选择触点进行开机后首次程控的经验.方法 分析60例接受DBS的帕金森病(Parkinson's disease,PD)病例资料,根据DBS术后程控不同,分为研究组30例和对照组30例.对照组采用传统调控法,每...     

滑轨CT在帕金森病患者脑深部电刺激手术中的应用价值

目的评价滑轨CT在帕金森病(PD)患者脑深部电刺激(DBS)手术中的临床应用效果。方法选择郑州大学第一附属医院神经外科自2019年5月至2023年5月采用DBS手术治疗的117例PD患者, 其中采用局麻46例, 全麻71例;73例患者行双侧丘脑底核(STN)DBS手术, 43例患者行双侧苍白球内侧部(GPi)DBS手术, 1例患者行右侧GPi DBS、左侧STN DBS手术。通过术前/术中滑轨CT图像与术前MRI图像融合, 计算患者术前计划靶点与术中实际靶点的空间距离(如空间距离大于2 mm, 表示电极位置偏移, 及时调整电极位置)。比较不同麻醉、手术方式患者术前计划靶点与术中实际靶点空间距离的差异。结果 117例PD患者手术均顺利完成, 共植入234根电极。无因电极错位或疗效欠佳行二次手术的患者。CT扫描期间未发生麻醉脱管及机械碰撞, 无颅内出血并发症。117例患者术前计划靶点与术中实际靶点的空间距离为(1.35±0.50) mm。术中4根电极的位置明显偏移, 术中即刻调整电极位置, 再次复查CT证实电极位置良好。全麻组和局麻组、STN组和GPi组患者双侧术前计划靶点与术中实际靶点空...     

人用DBS系统在脑深部电刺激猴模型构建中的应用

目的探讨人用脑深部电刺激(DBS)系统在构建猴脑深部电刺激模型中的应用。方法 4只偏侧帕金森病(PD)猴模型,按照猴脑立体定向图谱,在右侧丘脑底核(STN)植入脑深部刺激电极(Medtronic 3389),其中刺激组2只猴同期皮下植入Medtronic 7495型连接导线和Soletra TM7426型脉冲发生器,术后一周给予慢性高频电刺激。另2只偏侧PD模型猴仅在右侧STN植入电极,不植入脉冲发生器,作为对照组。连续观察12个月,进行运动障碍评分观察和阿朴吗啡(APO)诱发旋转实验。结果术后影像学观察电极前端均位于STN核范围内;刺激组同期植入脉冲发生器给予慢性高频电刺激,猴偏侧帕金森样症状明显改善,有效高频电刺激可以立即停止APO所诱发的旋转,而对照组在观察期内症状无明显缓解。结论人用DBS系统通过立体定向技术植入猴脑内特定靶点,可以有效的建立DBS动物模型,为DBS在神经系统疾病中的应用研究提供了良好的实验模型。     

脑深部电刺激治疗帕金森病的程控

目的探讨丘脑底核脑深部电刺激术治疗帕金森病(PD)的手术方法和脉冲发生器程控调节。方法自2000年1月～2004年2月用脑深部电刺激丘脑底核(STN)治疗帕金森病61例,其中单侧30例,双侧31例。采用磁共振扫描结合微电极记录技术进行靶点定位。术后用帕金森病评定量表(UPDRS)运动评分评价刺激效果。结果61例PD患者术后随访6～36个月,平均11．3个月。脉冲发生器开启时,在“关”状态下,UPDRS运动评分改善率45．2％;在“开”状态下,UPDRS运动评分改善率20．7％,未发现任何并发症。结论脑深部刺激(DBS)能有效控制帕金森病患者的症状,手术并发症少,术后可根据患者的症状调节参数,丘脑底核(STN)已成为治疗帕金森病的最佳靶点。     

Deep brain stimulation of both subthalamic nucleus and internal globus pallidus restores intracortical inhibition in Parkinson's disease paralleling apomorphine effects: a paired magnetic stimulation study.

OBJECTIVE: We investigated the effect of bilateral subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on intracortical inhibition (ICI) in patients with advanced Parkinson's disease (PD). METHODS: The activity of intracortical inhibitory circuits was studied in 4 PD patients implanted with stimulating electrodes both in STN and GPi by means of paired-pulse transcranial magnetic stimulation, delivered in a conditioning-test design at short (1-6 ms) interstimulus intervals (ISI). The effect of apomorphine on the same PD patients was also investigated. RESULTS: We observed that implanted PD patients showed a significant increase in ICI during either bilateral STN or GPi DBS at 3 ms ISI, and during bilateral STN DBS at 2 ms ISI in comparison to their off DBS condition. The same statistical improvement was observed during apomorphine infusion at 3 and 2 ms ISI. In each condition, the electrophysiological changes were associated with a significant clinical improvement as measured by the Unified Parkinson's Disease Rating Scale motor examination. CONCLUSIONS: These results are consistent with the hypothesis that basal ganglia DBS can mimic the effects of pharmacological dopaminergic therapy on PD patients cortical activity. We propose that in PD patients, the basal ganglia DBS-induced improvement of ICI may be related to a recovery in modulation of thalamo-cortical motor pathway.     

戴立体定向仪磁共振复查在帕金森病丘脑底核脑深部刺激术中的意义

目的 ;总结帕金森病丘脑底核脑深部刺激(Subthalamic nucleus deep brain sti mulation,STN-DBS)术中戴立体定向仪磁共振复查对提高定位准确性、降低手术并发症的意义。方法 2003年~2009年共有124例帕金森病病人进行了丘脑底核DBS手术,共191侧,其中男性64例,女性60例,年龄45~80岁,平均65.5±8.7岁。术中未用微电极记录技术,但均戴立体定向仪磁共振复查,对电极触点目标位和实际位有明显误差的病人术中进行必要的调整。结果治疗效果与国内外文献报道类似,但无脑出血等手术并发症。结论术中戴立体定向仪复查磁共振既可以提高定位的准确性,又可以避免应用微电极记录可能导致的脑出血并发症、缩短手术时间。     

Intra-operative recordings of local field potentials can help localize the subthalamic nucleus in Parkinson's disease surgery

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can be a highly effective treatment for Parkinson's disease (PD). However, therapeutic efficacy is limited by difficulties in consistently and correctly targeting this nucleus. Increasing evidence suggests that there is abnormal synchronization of beta frequency band activity (approximately 20 Hz) in the STN of PD patients, as reflected in the oscillatory nature of the local field potential (LFP). We hypothesized that an increase in the power of the LFP beta activity may provide intra-operative confirmation of STN targeting in patients undergoing STN implantation for the treatment of advanced PD. Accordingly, we recorded LFPs from the four contacts of DBS electrodes as the latter were advanced in 2 mm steps from a point 4-6 mm above the intended surgical target point in the STN, to a point 4 mm below this. Contacts were configured to give three bipolar recordings of LFPs. These were analyzed on 16 sides in 9 patients. The power in the 13-35 Hz band recorded at the lowest contact pair underwent a steep but focal increase during electrode descent. The depth of the peak beta activity showed excellent agreement with the level of the intra-operative clinical stun effect (k coefficient = 0.792). The depth of peak beta activity also showed 100% specificity and 100% sensitivity for placement within STN in comparison to pre- and Post-operative stereotactic MRI. Functional physiological localization of STN by the on-line spectral analysis of LFPs is quick to perform and may provide information directly relevant to the position of the electrode contact actually used for DBS.     

Effects of deep brain stimulation and medication on strength, bradykinesia, and electromyographic patterns of the ankle joint in Parkinson's disease.

We investigated the control of movement in 12 patients with Parkinson's disease (PD) after they received surgically implanted high-frequency stimulating electrodes in the subthalamic nucleus (STN). The experiment studied ankle strength, movement velocity, and the associated electromyographic patterns in PD patients, six of whom had tremor at the ankle. The patients were studied off treatment, ON STN deep brain stimulation (DBS), on medication, and on medication plus STN DBS. Twelve matched control subjects were also examined. Medication alone and STN DBS alone increased patients' ankle strength, ankle velocity, agonist muscle burst amplitude, and agonist burst duration, while reducing the number of agonist bursts during movement. These findings were similar for PD patients with and without tremor. The combination of medication plus STN DBS normalized maximal strength at the ankle joint, but ankle movement velocity and electromyographic patterns were not normalized. The findings are the first to demonstrate that STN DBS and medication increase strength and movement velocity at the ankle joint.     

Biophysical characterization of local field potential recordings from directional deep brain stimulation electrodes

ObjectiveTwo major advances in clinical deep brain stimulation (DBS) technology have been the introduction of local field potential (LFP) recording capabilities, and the deployment of directional DBS electrodes. However, these two technologies are not operationally integrated within current clinical DBS devices. Therefore, we evaluated the theoretical advantages of using directional DBS electrodes for LFP recordings, with a focus on measuring beta-band activity in the subthalamic nucleus (STN).MethodsWe used a computational model of human STN neural activity to simulate LFP recordings. The model consisted of 235,280 anatomically and electrically detailed STN neurons surrounding the DBS electrode, which was previously optimized to mimic beta-band synchrony in the dorsolateral STN. We then used that model system to compare LFP recordings from cylindrical and directional DBS contacts, and evaluate how the selection of different contacts for bipolar recording affected the LFP measurements.ResultsThe model predicted two advantages of directional DBS electrodes over cylindrical DBS electrodes for STN LFP recording. First, recording from directional contacts could provide additional insight on the location of a synchronous volume of neurons within the STN. Second, directional contacts could detect a smaller volume of synchronous neurons than cylindrical contacts, which our simulations predicted to be a ~0.5 mm minimum radius.ConclusionsSTN LFP recordings from 8-contact directional DBS electrodes (28 possible bipolar pairs) can provide more information than 4-contact cylindrical DBS electrodes (6 possible bipolar pairs), but they also introduce additional complexity in analyzing the signals.SignificanceIntegration of directional electrodes with DBS systems that are capable of LFP recordings could improve localization of targeted volumes of synchronous neurons in PD patients.     

双侧丘脑底核脑深部电刺激治疗帕金森病

目的 应用双侧丘脑底核脑深部电刺激（DBS）治疗难治性帕金森病（PD），并对其疗效作出评价。方法 对7例帕金森病患者采用磁共振导向立体定向及术中电生理验证方法，将刺激电极分别植入丘脑底核，采用同期或分期植入刺激发生器。术后1周用程控计算机在体外调速刺激参数，以达到最佳疗效。结果 6例患者术后均获得了显著的疗效。震颤完全消失，肌强直、步态、姿障碍以及药物所致的并发症明显,面时多巴胺类药物用量明显减少，1例曾接爱双侧丘脑腹中间核及一侧苍白球毁损后的患者只得到了轻度改善。结论 DBS法治疗中晚期PD，具有安全，副作用可逆转的优点，且可根据患者的不同状况及病情发展调节刺激参数达到最佳症状控制，完全控制震颤，明显改善肌张力障碍、步态、资势等运动障碍及药物所致的并发症，另外多巴胺类药物的用量也明显减少。     

Tremor reduction by subthalamic nucleus stimulation and medication in advanced Parkinson’s disease

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has proved to be effective for tremor in Parkinson’s disease (PD). Most of the recent studies used only clinical data to analyse tremor reduction. The objective of our study was to quantify tremor reduction by STN DBS and antiparkinsonian medication in elderly PD patients using an objective measuring system. Amplitude and frequency of resting tremor and re-emergent resting tremor during postural tasks were analysed using an ultrasound-based measuring system and surface electromyography. In a prospective study design nine patients with advanced PD were examined preoperatively off and on medication, and twice postoperatively during four treatment conditions: off treatment, on STN DBS, on medication, and on STN DBS plus medication. While both STN DBS and medication reduced tremor amplitude, STN DBS alone and the combination of medication and STN DBS were significantly superior to pre- and postoperative medication. STN DBS but not medication increased tremor frequency, and off treatment tremor frequency was significantly reduced postoperatively compared to baseline. These findings demonstrate that STN DBS is highly effective in elderly patients with advanced PD and moderate preoperative tremor reduction by medication. Thus, with regard to the advanced impact on the other parkinsonian symptoms, STN DBS can replace thalamic stimulation in this cohort of patients. Nevertheless, medication was still effective postoperatively and may act synergistically. The significantly superior efficacy of STN DBS on tremor amplitude and its impact on tremor frequency in contrast to medication might be explained by the influence of STN DBS on additional neural circuits independent from dopaminergic neurotransmission. Received in revised form: 27 April 2006     

Subthalamic nucleus stimulation in Parkinson''s disease: Postoperative CT–MRI fusion images confirm accuracy of electrode placement using intraoperative multi-unit recording

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is increasingly used to treat advanced Parkinson's disease (PD). The optimal method for targeting the STN before implanting the definitive DBS electrode is still a matter of debates. Beside methods of direct visualization of the nucleus based on stereotactic magnetic resonance imaging (MRI), the most often used technique for targeting STN consists in recording single-cell activity along exploratory tracks of 10-15mm in length, centered on the theoretical or MRI-defined target coordinates. Single-unit recordings with a microelectrode present various drawbacks. They are time-consuming if correctly performed and a single-cell precision is probably superfluous, taking into account the size of the implanted electrode. In this study, we present an original method of recording and quantification of a multi-unit signal recorded intraoperatively with a semi-microelectrode for targeting the STN. Twelve patients with advanced PD have been included and assessed clinically before and one year after bilateral STN-DBS electrode implantation guided by multi-unit electrophysiological recordings. After one year of chronic stimulation, all patients showed a marked clinical improvement. The motor score of the unified Parkinson's disease rating scale decreased by more than 57% and the required levodopa-equivalent daily dose by 59.5% in on-stimulation off-medication condition compared to off-stimulation off-medication condition. The accuracy of STN-DBS lead placement was confirmed on postoperative computed tomography (CT) scans, which were fused to preoperative T2-weighted MRI. The boundaries of the STN were easily determined by an increase in multi-unit signal amplitude, which was observed on average from 0.492mm below the rostral border of the STN down to 0.325mm above its caudal border. Signal amplitude significantly increased at the both rostral and caudal STN margins (P<0.05) and the level of neuronal activity easily distinguished inside from outside the nucleus. This study showed that STN boundaries could be adequately determined on the basis of intraoperative multi-unit recording with a semi-microelectrode. The accuracy of our method used for positioning DBS electrodes into the STN was confirmed both on CT-MRI fusion images and on the rate of therapeutic efficacy.     

Influence of deep brain stimulation and levodopa on sensory signs in Parkinson's disease

To examine the effects of levodopa (L ‐dopa) and deep brain stimulation of the subthalamic nucleus (STN‐DBS) on sensory symptoms and signs in Parkinson's disease (PD). Seventeen patients with PD were included. (1) Presence of sensory symptoms and (2) effects of L ‐dopa and STN‐DBS on sensory symptoms and signs [assessed by quantitative sensory testing (QST)] were examined 6 months after starting STN‐DBS. In addition, in 12 of these patients, presence of sensory symptoms prior and post STN‐DBS was compared. Pain was most frequently nociceptive. In about 30–40%, pain and sensory symptoms were associated with PD motor symptoms. In most of these cases, pain responded to L ‐dopa. Intensity of pain was reduced post STN‐DBS compared to pre STN‐DBS. L ‐Dopa had no influence on detection thresholds, whereas STN‐DBS improved thermal detection thresholds. However, thermal and mechanical pain thresholds were uninfluenced by L ‐dopa or STN‐DBS. Although some patients reported an improvement of pain with STN‐DBS or L ‐dopa, objectively pain sensitivity as assessed by QST was not altered by STN‐DBS or L ‐dopa suggesting that there is no evidence for a direct modulation of central pain processing by L ‐dopa or STN‐DBS. © 2010 Movement Disorder Society     

Early verbal fluency decline after STN implantation: Is it a cognitive microlesion effect?

The subthalamic nucleus (STN) is a frequent target of deep brain stimulation (DBS), which is used to treat patients with advanced Parkinson's disease (PD). However, few studies have assessed the relationship between the STN and the clinical characteristics of PD patients. We identified the STN of 17 PD patients and 7 control subjects using coronal Short TI Inversion Recovery (STIR) magnetic resonance imaging (MRI) and estimated the T2 relaxation time (T2) of the STN on the subsequent coronal images that were acquired from T2-weighted MRI. The relationships between the STN T2 measurements and the PD patients' age, disease duration, laterality, and clinical scores were examined. STN T2 measurements tended to be lower in PD patients than in controls, although the difference was not significant. STN T2 measurements were significantly and inversely correlated (p=0.03) with scores on the Unified Parkinson's Disease Rating Scale (UPDRS) part 1, which was applied to evaluate the mentation, behavior, and mood of PD patients. However, no significant correlations were found between the STN T2 measurements and the patients' age, disease duration, laterality, or motor clinical scores. These results suggest that degeneration of the STN in PD patients may contribute to their neuropsychological symptoms.