Neurological Surgery 脳神経外科49巻4号

2021年07月発行

特集 定位・機能神経外科の基礎と臨床 Ⅲ　定位・機能神経外科の外科的治療手技 脳深部刺激療法（DBS）

DBSの刺激調整法とデバイスの特徴

著者： 佐々木達也¹ 伊達勲¹

所属機関： ¹岡山大学大学院医歯薬学総合研究科脳神経外科

ページ範囲：P.829 - P.837

Point
・刺激調整の基本は，各電極の症状改善閾値と副作用閾値を調べ（モノポーラ・レビュー），治療域の広い電極を使用することである．
・副作用出現時には症状と標的周囲の機能解剖とを照らし合わせ，原因となっている部位への刺激波及を避ける工夫をする．
・各デバイスが有するディレクショナル刺激，adaptive DBSなどの特殊な刺激方法を積極的に利用する．

参考文献

1）Volkmann J, et al：Introduction to the programming of deep brain stimulators. Mov Disord 17（Suppl 3）：S181-S187, 2002

2）Volkmann J, et al：Basic algorithms for the programming of deep brain stimulation in Parkinson's disease. Mov Disord 21（Suppl 14）：S284-S289, 2006

3）Picillo M, et al：Programming deep brain stimulation for Parkinson's disease：the Toronto Western Hospital Algorithms. Brain Stimul 9：425-437, 2016

4）Koeglsperger T, et al：Deep brain stimulation programming for movement disorders：current concepts and evidence-based strategies. Front Neurol 10：410, 2019

5）Williams NR, et al：STN vs. GPi deep brain stimulation：translating the rematch into clinical practice. Mov Disord Clin Pract 1：24-35, 2014

6）Thobois S, et al：Non-motor dopamine withdrawal syndrome after surgery for Parkinson's disease：predictors and underlying mesolimbic denervation. Brain 133（Pt 4）：1111-1127, 2010

7）Voon V, et al：A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson's disease. Brain 131（Pt 10）：2720-2728, 2008

8）Nirenberg MJ：Dopamine agonist withdrawal syndrome and non-motor symptoms after Parkinson's disease surgery. Brain 133（11）：e155；author reply e6, 2010

9）Rizzone MG, et al：Long-term outcome of subthalamic nucleus DBS in Parkinson's disease：from the advanced phase towards the late stage of the disease? Parkinsonism Relat Disord 20：376-381, 2014

10）Janssen ML, et al：Subthalamic nucleus high-frequency stimulation for advanced Parkinson's disease：motor and neuropsychological outcome after 10 years. Stereotact Funct Neurosurg 92：381-387, 2014

11）Deuschl G, et al：Deep brain stimulation：postoperative issues. Mov Disord 21（Suppl 14）：S219-S237, 2006

12）Kern DS, et al：Interleaving stimulation in Parkinson's disease, tremor, and dystonia. Stereotact Funct Neurosurg 96：379-391, 2018

13）Mahlknecht P, et al：Pyramidal tract activation due to subthalamic deep brain stimulation in Parkinson's disease. Mov Disord 32：1174-1182, 2017

14）Aström M, et al：Patient-specific model-based investigation of speech intelligibility and movement during deep brain stimulation. Stereotact Funct Neurosurg 88：224-233, 2010

15）Tripoliti E, et al：Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease. Neurology 76：80-86, 2011

16）Moreau C, et al：Modulation of dysarthropneumophonia by low-frequency STN DBS in advanced Parkinson's disease. Mov Disord 26：659-663, 2011

17）Ortega-Cubero S, et al：Effect of deep brain stimulation of the subthalamic nucleus on non-motor fluctuations in Parkinson's disease：two-years' follow-up. Parkinsonism Relat Disord 19：543-547, 2013

18）Castrioto A, et al：Mood and behavioural effects of subthalamic stimulation in Parkinson's disease. Lancet Neurol 13：287-305, 2014

19）Bejjani BP, et al：Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med 340：1476-1480, 1999

20）Chopra A, et al：Underlying neurobiology and clinical correlates of mania status after subthalamic nucleus deep brain stimulation in Parkinson's disease：a review of the literature. J Neuropsychiatry Clini Neurosci 24：102-110, 2012

21）Priori A：Technology for deep brain stimulation at a gallop. Mov Disord 30：1206-1212, 2015

22）Pollo C, et al：Directional deep brain stimulation：an intraoperative double-blind pilot study. Brain 137（Pt 7）：2015-2026, 2014

23）Rebelo P, et al：Thalamic directional deep brain stimulation for tremor：spend less, get more. Brain Stimul 11：600-606, 2018

24）Vitek JL, et al：Subthalamic nucleus deep brain stimulation with a multiple independent constant current-controlled device in Parkinson's disease（INTREPID）：a multicentre, double-blind, randomised, sham-controlled study. Lancet Neurol 19：491-501, 2020

25）Bouthour W, et al：Short pulse width in subthalamic stimulation in Parkinson's disease：a randomized, double-blind study. Mov Disord 33：169-173, 2018

26）Khoo HM, et al：Low-frequency subthalamic nucleus stimulation in Parkinson's disease：a randomized clinical trial. Mov Disord 29：270-274, 2014

27）Xie T, et al：Effect of low versus high frequency stimulation on freezing of gait and other axial symptoms in Parkinson patients with bilateral STN DBS：a mini-review. Transl Neurodegener 6：13, 2017