NEURALREGENERATIONRESEARCHVolume7,Issue18,June2012Citethisarticleas:NeuralRegenRes.2012;7(18):1428-1435.1428JinchuanLiang★,Master,Physician,DepartmentofNeurosurgery,ChanghaiHospitaloftheSecondMilitaryMedicalUniversityofChinesePLA,Shanghai200433,ChinaCorrespondingauthor:XiaowuHu,Master,Professor,DepartmentofNeurosurgery,ChanghaiHospitaloftheSecondMilitaryMedicalUniversityofChinesePLA,Shanghai200433,Chinahuxiaowu25@sina.comReceived:2012-01-08Accepted:2012-04-23(N20110107002/WJ)LiangJC,HuXW,ZhouXP,JiangXF,CaoYQ,WangLX,JinAG,LiuJM.Five-yearfollow-upof23asymmetricalParkinson’sdiseasepatientstreatedwithunilateralsubthalamicnucleusstimulation.NeuralRegenRes.2012;7(18):1428-1435.www.crter.cnwww.nrronline.orgdoi:10.3969/j.issn.1673-5374.2012.18.010Five-yearfollow-upof23asymmetricalParkinson’sdiseasepatientstreatedwithunilateralsubthalamicnucleusstimulation*★JinchuanLiang1,XiaowuHu1,XiaopingZhou1,XiufengJiang1,YiqunCao1,LaixingWang1,AiguoJin2,JianminLiu11DepartmentofNeurosurgery,ChanghaiHospitaloftheSecondMilitaryMedicalUniversityofChinesePLA,Shanghai200433,China2DepartmentofRadiology,ChanghaiHospitaloftheSecondMilitaryMedicalUniversityofChinesePLA,Shanghai200433,ChinaAbstractInthisstudy,23asymmetricalParkinson’sdiseasepatientsweretreatedwithunilateraldeepbrainstimulationofthesubthalamicnucleusandfollowedupfor5years.At5yearsafterstimulationtreatment,UnifiedParkinson’sDiseaseRatingScaleII,IIIandaxialsymptomscoresintheoff-drugconditionweresignificantlyincreasedcomparedthoseatbaseline.However,totalUnifiedParkinson’sDiseaseRatingScaleII,IIIandaxialsymptomscoresweresignificantlylowerwithstimulation-oncomparedwiththesynchronousstimulation-offstateinoff-drugcondition,andthemotorsymptomsofcontralateralsidelimbswereeffectivelycontrolled.OnlylowHoehn-Yahrstagewascorrelatedwithgoodlong-termpostoperativeimprovementinmotorsymptoms.Themeanlevodopa-equivalentdailydoseafterstimulationtreatmentwassignificantlylowerthanthatbeforetreatment,butdyskinesiasbecameworse.OurexperimentalfindingsindicatethatunilateraldeepbrainstimulationofthesubthalamicnucleusisaneffectivetreatmentforimprovingmotorsymptomsinwellselectedasymmetricalParkinson’sdiseasepatientspresentingnosevereaxialsymptomsanddyskinesias.KeyWordsParkinson’sdisease;deepbrainstimulation;subthalamicnucleus;neuralregenerationAbbreviationsPD,Parkinson’sdisease;DBS,deepbrainstimulation;STN,subthalamicnucleus;UPDRS,UnifiedParkinson’sDiseaseRatingScaleINTRODUCTIONSubthalamicnucleus(STN)deepbrainstimulation(DBS)hasbecomethemostimportantneurosurgicaltherapyforadvancedParkinson’sdisease(PD)[1-4].However,bilateralproceduresaremoretime-consumingandinvasivethanunilateralprocedures,andmaybeassociatedwithincreasedrisksofsurgicalandneurologicalcomplicationsandneuropsychologicalsequelae[5-9].Recently,severalstudieshaveshownthatunilateralSTNDBSproducesasignificantimprovementinadvancedPDpatientswithouttheadversenessreportedinstudiesofbilateralSTNDBS[10-14].However,thefollow-updurationsofmoststudieswereonly3–12monthsorthesamplesizeswerenotlargeenoughforstatisticalanalysis.Therearestilltwoimportantquestionsinthisfield:(1)isunilateralSTNDBSalong-termeffectivecandidatetherapyforadvancedasymmetricalPDpatients?(2)Howcanappropriatepatientsbeselectedtoensuregoodresultsandavoidunnecessarysecondaryoperations?Thisstudyfollowedaprospectivecohortstudyof23patient...
