＜シンポジウム（2）―6―1＞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1）, 小林 一太1）2）, 大島 秀規1）2）, 山本 隆充1）, 片山 容一2）
1）日本大学医学部脳神経外科学系応用システム神経科学分野〔〒173―8610 東京都板橋区大谷口上町30―1〕
2）同 医学部脳神経外科学系神経外科学分野
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.
Full Text of this Article in Japanese PDF (169K)
(臨床神経, 52：1095−1097, 2012)
key words：脳深部刺激療法，パーキンソン病，視床下核，淡蒼球内節，ドパ反応性
（受付日：2012年5月24日）
