Long-Term Follow-Up of Unilateral Deep Brain Stimulation Targeting the Caudal Zona Incerta in 13 Patients with Parkinsonian Tremor.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-01-01 Epub Date: 2023-10-25 DOI:10.1159/000533793

Rasmus Stenmark Persson, Anders Fytagoridis, Maxim Ryzhkov, Marwan Hariz, Patric Blomstedt

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Abstract

Introduction: Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD) and other movement disorders. The ventral intermediate nucleus of the thalamus is considered as the target of choice for tremor disorders, including tremor-dominant PD not suitable for DBS in the subthalamic nucleus (STN). In the last decade, several studies have shown promising results on tremor from DBS in the posterior subthalamic area (PSA), including the caudal zona incerta (cZi) located posteromedial to the STN. The aim of this study was to evaluate the long-term effect of unilateral cZi/PSA-DBS in patients with tremor-dominant PD.

Methods: Thirteen patients with PD with medically refractory tremor were included. The patients were evaluated using the motor part of the Unified Parkinson Disease Rating Scale (UPDRS) off/on medication before surgery and off/on medication and stimulation 1-2 years (short-term) after surgery and at a minimum of 3 years after surgery (long-term).

Results: At short-term follow-up, DBS improved contralateral tremor by 88% in the off-medication state. This improvement persisted after a mean of 62 months. Contralateral bradykinesia was improved by 40% at short-term and 20% at long-term follow-up, and the total UPDRS-III by 33% at short-term and by 22% at long-term follow-up with stimulation alone.

Conclusions: Unilateral cZi/PSA-DBS seems to remain an effective treatment for patients with severe Parkinsonian tremor several years after surgery. There was also a modest improvement on bradykinesia.

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13例帕金森氏震颤患者的单侧深部脑刺激靶向尾区的长期随访。

引言：脑深部刺激（DBS）是治疗帕金森病（PD）和其他运动障碍的一种公认方法。丘脑腹侧中间核被认为是震颤疾病的首选靶点，包括不适合丘脑底核（STN）DBS的震颤显性PD。在过去的十年里，几项研究对丘脑底后部区域（PSA）的DBS震颤显示了有希望的结果，包括位于STN后方的尾侧incerta带（cZi）。本研究的目的是评估单侧cZi/PSA-DBS对震颤为主的帕金森病患者的长期疗效。使用统一帕金森病评定量表（UPDRS）的运动部分对患者进行评估，术前停药/停药，术后1-2年（短期）停药和刺激，术后至少3年（长期）。结果：在短期随访中，DBS在停药状态下将对侧震颤改善了88%。这种改善持续了平均62个月。对侧运动迟缓在短期和长期随访中分别改善了40%和20%，总UPDRS-III在短期和单独刺激的长期随访中改善了33%和22%。结论：单侧cZi/PSA-DBS对术后数年的严重帕金森氏震颤患者似乎仍然是一种有效的治疗方法。运动迟缓也有适度的改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.