Abstract BACKGROUND Subthalamic nucleus (STN) and globus pallidus interna (GPi) are the most effective targets in deep brain stimulation (DBS) treatment for Parkinson disease (PD). However, the individualized selection of targets remains a clinical challenge. OBJECTIVE To combine unilateral STN and contralateral GPi stimulation (STN DBS in one brain hemisphere and GPi DBS in the other) to maximize the clinical advantages of each target while inducing fewer adverse side effects in selected patients with PD because each target has its own clinical effects and risk profiles. METHODS We reviewed the clinical outcomes of 8 patients with idiopathic PD treated with combined unilateral STN and contralateral GPi DBS. Clinical outcome assessments, focusing on motor and nonmotor symptoms, were performed at baseline and 6-mo and 12-mo follow-up. We performed the assessments under the following conditions: medication on and off (bilateral stimulation on and off and unilateral STN stimulation on). RESULTS Patients showed a significant improvement in motor symptoms, as assessed by the Unified Parkinson Disease Rating Scale III (UPDRS-III) and Timed Up-and-Go Test (TUG), in the off-medication/on-stimulation state at 6-mo and 12-mo follow-up. Also, patients reported a better quality of life, and their intake of levodopa was reduced at 12-mo follow-up. In the on-medication condition, bilateral stimulation was associated with an improvement in axial symptoms, with a 64% improvement in measures of gait and falls at 12-mo follow-up. No irreversible adverse side effects were observed. CONCLUSION Our findings suggest that combined unilateral STN and contralateral GPi DBS could offer an effective and well-tolerated DBS treatment for certain PD patients.

中文翻译：

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联合单侧丘脑底核和对侧苍白球内部深部脑刺激治疗帕金森病：症状定制刺激的初步研究

摘要 背景丘脑底核（STN）和苍白球内部（GPi）是帕金森病（PD）脑深部刺激（DBS）治疗中最有效的靶点。然而，目标的个体化选择仍然是一个临床挑战。目的 结合单侧 STN 和对侧 GPi 刺激（一个脑半球的 STN DBS 和另一个脑半球的 GPi DBS）最大限度地发挥每个目标的临床优势，同时在选定的 PD 患者中减少不良副作用，因为每个目标都有自己的临床效果和风险概况。方法 我们回顾了 8 名特发性 PD 患者联合单侧 STN 和对侧 GPi DBS 治疗的临床结果。临床结果评估，侧重于运动和非运动症状，在基线和 6 个月和 12 个月的随访中进行。我们在以下条件下进行了评估：开启和关闭药物治疗（开启和关闭双侧刺激以及开启单侧 STN 刺激）。结果 根据帕金森病统一评定量表 III (UPDRS-III) 和定时起跳测试 (TUG) 评估，患者在 6 mo 和 12 个月的随访。此外，患者报告了更好的生活质量，并且在 12 个月的随访中他们的左旋多巴摄入量减少了。在药物治疗的情况下，双侧刺激与轴性症状的改善有关，在 12 个月的随访中步态和跌倒的测量有 64% 的改善。没有观察到不可逆的不良副作用。