臨床神経学
Online ISSN : 1882-0654
Print ISSN : 0009-918X
ISSN-L : 0009-918X
6 パーキンソン病のDBS治療における神経内科医の役割
脳深部刺激療法の適応(脳神経外科医の立場から)
深谷 親小林 一太大島 秀規山本 隆充片山 容一
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2012 年 52 巻 11 号 p. 1095-1097

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It is obvious that deep brain stimulation (DBS) is one of the useful treatment choices for progressive Parkinson disease (PD). The main targets for DBS for PD are the thalamic Vim nucleus, globus pallidus interna (GPi), and subthalamic nucleus (STN). Vim-DBS is useful for tremor but not very effective for other Parkinson symptoms. Therefore, presently, STN and GPi are the common targets for DBS for PD. Diminishing the dose of anti-PD drugs is possible usually only after STN-DBS. However, no evident differences in the effect between STN-DBS and GPi-DBS are noted in the majority of studies. Appropriate indication should be decided on the basis of individual target's feature. Dopa responsiveness is a very important factor when considering the operative indications for both STN-DBS and GPi-DBS. CAPSIT protocol is usually used to evaluate the dopa responsiveness. DBS is considered to be characterized by the bottom-up and substitution effects. The disappearance of wearing-off is expected owing to the bottom-up effect and the disappearance of the side effects of anti-PD drugs is expected owing to the substitution effect. Age at surgery, duration of PD, and degree of dopa responsiveness are important factors for outcome prediction. On the other hand, the rate of complications such as cognitive decline, psychosis, and intracranial hemorrhage is relatively high in elderly patients.

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© 2012 日本神経学会
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