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首页> 外文期刊>Neurosurgery >Electrical stimulation of the prelemniscal radiation in the treatment of Parkinson's disease: an old target revised with new techniques.
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Electrical stimulation of the prelemniscal radiation in the treatment of Parkinson's disease: an old target revised with new techniques.

机译：电刺激肾上腺前辐射治疗帕金森氏病：用新技术修订的旧靶标。

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OBJECTIVE: In the treatment of tremor and rigidity in patients with Parkinson's disease (PD), the prelemniscal radiation (RAPRL), a subthalamic bundle of fibers, is an exquisite target that can be visualized easily on ventriculograms. We sought to evaluate the effect of electrical stimulation of the RAPRL on symptoms and signs of PD in a long-term trial and to determine the localization of the stimulated area by means of stereotactic magnetic resonance imaging studies. METHODS: Ten patients with PD predominantly on one side had tetrapolar electrodes stereotactically oriented through a frontal parasagittal approach to the RAPRL contralateral to the most prominent symptoms. Preoperative and postoperative evaluations at 3, 6, 9, and 12 months after surgery were performed using conventional PD scales and quantitative evaluations of tremor amplitude and reaction time. Stereotactic high-resolution magnetic resonance imaging studies with the electrodes in place were used for anatomic localization. RESULTS: In all patients, temporary suppression of tremor occurred when the electrodes reached the target. The most effective stimulation was obtained when the pair of contacts was placed in the RAPRL. Long-term stimulation at 130 Hz, 0.09 to 0.450 milliseconds, and 1.5 to 3.0 V produced significant improvement in tremor and rigidity and mild improvement in bradykinesia. CONCLUSION: The RAPRL is an effective target for the alleviation of tremor and rigidity in patients with PD by either lesioning or neuromodulation; however, neuromodulation has the advantage of not inducing an increase in bradykinesia. The stimulated area seems to be independent of the subthalamic nucleus.
机译：目的：在帕金森氏病（PD）患者的震颤和僵硬的治疗中，丘脑底下纤维束（前丘脑放射）（RAPRL）是一个精致的目标，可以在心室图上轻松看到。我们试图在长期试验中评估RAPRL的电刺激对PD症状和体征的影响，并通过立体定向磁共振成像研究确定受刺激区域的定位。方法：10例PD主要在一侧的患者，通过额旁矢状入路对RAPRL的最主要症状进行立体定向定向。使用常规的PD量表对震颤幅度和反应时间进行定量评估，以在术后3、6、9和12个月进行术前和术后评估。电极就位的立体定向高分辨率磁共振成像研究用于解剖定位。结果：在所有患者中，当电极到达目标位置时，都会暂时抑制震颤。将一对触点放在RAPRL中可获得最有效的刺激。在130 Hz，0.09至0.450毫秒和1.5至3.0 V的长期刺激下，震颤和刚度得到了显着改善，运动迟缓得到了轻度改善。结论：RAPRL是通过病变或神经调节减轻PD患者的震颤和僵硬的有效靶点;然而，神经调节的优点是不引起运动迟缓的增加。受刺激的区域似乎独立于丘脑下核。

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