Subthalamic deep brain stimulation in lingual dystonia: A case series study

Lingual dystonia is a rare disease, which often interferes with daily activities severely. The efficacy of GPi-DBS on patients with refractory lingual symptoms has been previously reported, while high-level evidence is inadequate. Uniquely, we retrospect six lingual dystonia patients treating with subthalamic DBS, showing its immediate, and long-lasting efficacy.     

丘脑底核电刺激对猴偏侧帕金森病纹状体神经递质的影响

目的 探讨应用微透析技术在慢性STN—DBS对纹状体细胞外液多巴胺及代谢产物的影响。方法 选择已经成功安装脑深部刺激电极的偏侧PD猕猴模型2只，分别在打开脉冲发生器前、后的不同时间点取样（开机后8h、1周、1个月、2个月）。应用高效液相电化学方法检测开机前后的尾状核和壳核细胞外液的多巴胺（DA）及其代谢产物含量。结果 电极侧壳核和尾状核的DA在开机后8h、1周、1个月、2个月相应地分别较各自开机前的DA含量增高了39％、91％、111％、114％和31％、91％、106％、102％（P〈0．05）。电极侧壳核和尾状核HVA／DA在开机后8h分别较各自开机前增高了186％和91％（P〈0．05），而开机后1周、1个月、2个月HVA／DA较开机前无明显变化（P〉0．05）。电极侧的多巴胺周转率在开机后的各时间点均显著低于非电极侧（P〈0．01）。结论 STN—DBS可有效的改善猴偏侧PD模型的症状，应用微透析取样技术结合高效液相色谱测，定法发现在给予有效电刺激后可增加刺激侧纹状体细胞外液的多巴胺及其代谢产物含量。为STN—DBS治疗帕金森病提供理论依据。     

丘脑底核电刺激治疗继发性肌张力障碍

目的 探讨丘脑底核（STN）的脑深部电剌激（DBS）治疗继发性肌张力障碍的可行性、适应证和并发症。方法 5例行双侧STN—DBS，1例行单侧STN—DBS。结果 术中利用微电极记录的电信号获得STN的准确靶点定位，电刺激后患者肌张力有不同程度下降，但扭转改善不明显。随访半年至3年，6例患者中，药物引起的迟发性肌张力障碍及外伤性肌张力障碍的患者疗效理想，BFMDRS评分改善均在90％以上，且随着随访时间的延长，效果持续不断改善；其余4例患者疗效不佳，4例均肌张力略有改善，其中1例扭转略改善，1例语言及步态略有改善。手术后患者均无明显合并症，但1例术后16个月发现左侧电极折断，后取出。结论 DBS治疗迟发性和外伤性继发性肌张力障碍效果理想，而对于缺氧或脑基底节区弥漫性损害的继发性肌张力障碍效果不佳；STN可以成为治疗本病的理想靶点；术中应根据电生理记录结果和肌张力的轻度改善作为靶点定位的指标；手术无明显合并症。     

脑深部刺激术中丘脑底核靶点定位方法探讨

目的 分析脑深部刺激术(DBS)中丘脑底核(STN)靶点的定位方法。方法 对30例帕金森病(PD)患者进行STN DBS治疗，其中单侧19例，双侧11例。MRI扫描后，采用图像和坐标相结合的方法计算STN靶点坐标，微电极记录细胞放电，植入电极刺激，观察刺激效果和不良反应。结果 MRI能显示STN，微电极记录能明确STN边界，术中植入电极刺激能观察患者的刺激效果和不良反应。结论 MRI图像直接定位STN较准确，微电极记录和植入电极刺激能对靶点定位作进一步验证和适当调整。     

Possible intermixing of neurons from the subthalamic nucleus and substantia nigra pars compacta in the guinea-pig

A population of cells in the anterior substantia nigra pars compacta (SNPc) of the guinea-pig have been reported previously that differ from classical dopaminergic neurons in terms of their active and passive membrane properties. To investigate this population further, anterior nigral neurons (n=17) were compared with neurons in the adjacent subthalamic nucleus (STN; n=26). The anterior nigral neurons were found to be indistinguishable from STN neurons in their action potential characteristics, firing rate, resting membrane potential and input resistance. A low-threshold calcium conductance and anomalous rectification could be demonstated in cells from both groups. Furthermore, the gross morphological characteristics of anterior nigral neurons and STN neurons were very similar, as assessed following the intracellular injection of biocytin. A further similarity was seen in the response of the two cell groups to cyanide (200 M) and apomorphine (500 M). Cyanide hyperpolarised the membrane potential of all STN neurons and the majority (77.8%) of anterior nigral neurons, in both cases producing a concomitant reduction in firing rate. These changes were accompanied by an increase in membrane conductance for potassium ions. Apomorphine depolarised the membrane potential of all STN neurons and anterior nigral neurons, in most cases increasing the input resistance (83.3% of STN neurons and 100% of anterior nigral neurons). In both groups of cells, when firing rate was affected, an increase was usually seen. Given the physiological, morphological and pharmacological similarities of STN and anterior nigral neurons, the most parsimonious interpretation is that the anterior nigral neurons belong to the STN. However, the anterior nigral neurons were found in slices that, when resectioned, contained tyrosine hydroxylase (TH)-immunoreactive cell bodies in every section, in a location corresponding to the SNPc. The implication is that in the guinea pig the SNPc and STN (usually considered to be anatomically distinct nuclei) intermix at this level for several hundred microns. This close association of the STN and the compacta was further demonstrated by the presence of TH-positive varicose and non-varicose neuronal processes within the STN.     

Transsynaptic induction of c-fos in basal forebrain,diencephalic and midbrain neurons following AMPA-induced activation of the dorsal and ventral striatum

In these experiments, induction of the immediate early gene c-fos following excitation of striatal neurons has been used to investigate the organization of the ventral and dorsal striatopallidal systems and the relationship between striatal neurons and cholinergic neurons of the nucleus basalis magnocellularis (of Meynert, nbM). The results demonstrate that FOS immunoreactivity (ir) can be detected in ventral and dorsal striatal neurons following infusions of the non-N-methyl-d-aspartic acid (NMDA) glutamate receptor agonist -amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA). This activation and increased expression of FOS in striatal neurons was itself associated with the sustained appearance of FOS-ir in neurons of the ipsilateral ventral and dorsal pallidum, subthalamic nucleus and some thalamic nuclei. Infusions of AMPA into the ventral striatum (VS), but not the dorsal striatum (DS), also resulted in the appearance of FOS-ir in a proportion (17%) of the cholinergic neurons of the nbM. By combining the retrograde transport of Fluoro-Gold with FOS immunocytochemistry, it was also possible to demonstrate that approximately 46% and 58% of the pallidal neurons containing FOS-ir after infusions of AMPA into the VS or DS, respectively, directly project to the subthalamic nucleus. Taken together, these observations suggest that visualizing the protein product of transsynaptic c-fos induction provides an effective way to study the topographic and transsynaptic, within-system consequences of striatal activation.     

丘脑底核高频电刺激对猴帕金森病模型丘脑底核局部脑组织结构的影响

目的探讨丘脑底核高频电刺激对猴帕金森病模型丘脑底核局部脑组织结构的影响,评价长期丘脑底核高频电刺激治疗帕金森病的安全性。方法成功制作的右侧帕金森病猴模型给予丘脑底核高频电刺激,分别在打开脉冲发生器前、开机后的1周和12个月取电极周围脑组织行组织学检查。结果开机前及开机后1周STN电极通道内可见细胞坏死和淋巴细胞浸润,电极周围和末端可见胶质增生,开机后12个月电极周围和末端组织内少见胶质增生及淋巴细胞的浸润,电极通道的周围纤维组织形成膜样的结构包绕电极。结论长期丘脑底核高频电刺激对局部周围脑组织的异物反应小,耐受性较好。