双侧苍白球内侧部电刺激术作为丘脑底核电刺激术治疗帕金森病失效后挽救性治疗策略的可行性研究OA

Objective To investigate the feasibility and efficacy of bilateral globus pallidus internus deep brain stimulation(GPi-DBS)as a rescue treatment strategy after failed subthalamic nucleus deep brain stimulation(STN-DBS)in the management of Parkinson disease(PD).Methods A retrospective analysis was conducted on two patients who had undergone STN-DBS treatment at another hospital for Parkinson's disease(PD)but showed poor therapeutic response.Af-ter evaluation at the Central Hospital affiliated with Shandong First Medical University confirmed that efficacy could not be restored through parameter optimization or medication adjustment,both patients underwent a procedure to retain their original STN-DBS system and implant bilateral GPi-DBS systems.Following the deactivation of the STN-DBS,surgical outcomes were assessed by comparing preoperative and postoperative Unified Parkinson's Disease Rating Scale Part Ⅲ(UPDRS-Ⅲ)scores under conditions of active GPi-DBS,as well as during"on"and"off"medication periods.Results Both patients successfully retained their original STN-DBS systems and underwent uneventful implantation of bi-lateral GPi-DBS systems,without complications such as bleeding or infection.Six months postoperatively,Patient 1 showed a UPDRS-Ⅲ improvement rate of 61.21%during the"on"medication phase and 68.92%during the"off"medica-tion phase with GPi-DBS activated.Patient 2 demonstrated an improvement rate of 55.81%during the"on"medication phase and 59.34%during the"off"medication phase under GPi-DBS activation.Both patients exhibited significant im-provements in dyskinesia,speech,and balance.Conclusion Retaining the original STN system with simultaneous bilat-eral GPi-DBS reimplantation may be a safe and effective rescue treatment strategy for PD patients who experience a decline in efficacy or severe complications following STN-DBS surgery that cannot be improved by optimizing medication or pro-gramming parameters.