Multi-target strategy for Parkinsonian patients: The role of deep brain stimulation in the centromedian-parafascicularis complex

作者：Stefani Alessandro^*; Peppe Antonella; Pierantozzi Mariangela; Galati Salvatore; Moschella Vincenzo; Stanzione Paolo; Mazzone Paolo

来源：Brain Research Bulletin, 2009, 78(2-3): 113-118.

DOI：10.1016/j.brainresbull.2008.08.007

• Parkinson's disease
• Intra-laminar thalamic nuclei
• Deep brain stimulation

The intra-laminar (IL) thalamic complex, composed of centromedian (CM) and parafascicular(Pf) nucleus, is a strategic crossroad for the activity of the basal ganglia and is recently regaining its position has a putative neurosurgical target for Parkinsonian syndromes. The multi-target approach we have encouraged since the late nineties has allowed the combined implantation of a standard target (the subthalamic nucleus-STN or the internal pallidus-GPi) plus an innovative one (CM/Pf) in well-identified Parkinson's disease (PD) patients; hence, it is possible to study, in the same PD patients, the specific target-mediated effects on different clinical signs.
Here, we focus on the potential usefulness of implanting the CM/Pf complex when required in the management of contra-lateral tremor (resistant to standard deep brain stimulation-DBS - in STN -, n = 2) and disabling involuntary movements, partially responsive to GPi-DBS (n = 6). When considering global UPDRS scores, CM/Pf-DBS ameliorate extra-pyramidal symptoms but not as strongly as STN (or GPi) does. Yet, CM/Pf acts very powerfully on tremor and contributes to the long-term management of L-Dopa-induced involuntary movements.
The lack of cognitive deficits and psychic impairment associated with the improvement of their quality of life, in our small cohort of CM/Pf implanted patients, reinforces the notion of CM/Pf as a safe and attractive area for surgical treatment of advanced PD, possibly affecting not only motor but also associative functions.

• 出版日期2009-2-16