早期パーキンソン病に対する一側視床下核刺激療法

Unilateral Subthalamic Stimulation for Early-stage Parkinson's Disease

要旨　パーキンソン病（PD）に対する視床下核刺激療法（STN DBS）は，運動合併症（日内変動やdyskinesia）を伴う進行期患者を対象とすることが一般的であるが，知的機能が正常に保たれ，精神症状が出現しにくい比較的早期に手術を行う利点も考えられる。当施設にて一側STN DBSを行った一側パーキンソン症状優位の早期PD患者6例について，術前/術後6カ月のOff-drug UPDRS part 3 scoreおよびSchwab and England ADL scaleを比較した。その結果，術後6カ月時点でのUPDRS part 3の合計スコアは平均73.0％改善した。副作用は1例に無症候性脳室内出血を認めた。文献的には進行期に対する両側STN DBSの‘OFF’UPDRS part 3 scoreの改善度は，術後6～12カ月で40～60％とされており，比較的早期の一側優位のPDに対する一側STN DBSは有用と思われた。

Abstract

　According to evidenced-based criteria, surgical treatment with subthalamic stimulation is indicated for advanced Parkinson's disease with severe motor complications. Currently, the treatment is indicated for patients in whom medical treatment has failed even if the patient is still in an early stage. This study investigated the efficacy and safety of unilateral subthalamic stimulation for patients with early-stage Parkinson's disease. We evaluated the Unified Parkinson's Disease Rating Scale （UPDRS） and the Schwab England ADL score before and 6 months after this treatment in 6 patients with early-stage Parkinson's disease demonstrating predominantly unilateral parkinsonian symptoms. We implanted a stimulation electrode （model 3387 or 3389） unilaterally on the side showing dominate symptoms, using both MRI and electrophysiological guidance. Six months after the beginning of stimulation, the UPDRS motor score without medication was improved by 64％ and the Schwab England ADL score was improved by 23％. There were no adverse events except for asymptomatic intra-ventricular hemorrhage in one patient.

　Unilateral subthalamic stimulation is a useful treatment for patients with early-stage Parkinson's disease showing predominantly unilateral parkinsonian symptoms. However, long-term results of subthalamic stimulation for early-stage patients remain unclear.

（Received : January 10, 2005）