| Project/Area Number |
10470294
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| Research Category |
Grant-in-Aid for Scientific Research (B)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Cerebral neurosurgery
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| Research Institution | KYUSHU UNIVERSITY |
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Principal Investigator |
SHIMA Fumio Graduate School of Medicine, KYUSHU UNIVERSITY Ass.Prof., 大学院・医学研究院, 助教授 (40117130)
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| Co-Investigator(Kenkyū-buntansha) |
SASAKI Masayuki Graduate School of Medicine, KYUSHU UNIVERSITY Instructor, 大学院・医学研究院, 助手 (40240907)
KUWABARA Yasuo Graduate School of Medicine, KYUSHU UNIVERSITY Ass.Prof., 大学院・医学研究院, 助教授 (30150436)
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| Project Period (FY) |
1998 – 1999
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| Project Status |
Completed (Fiscal Year 1999)
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| Budget Amount *help |
¥9,600,000 (Direct Cost: ¥9,600,000)
Fiscal Year 1999: ¥1,000,000 (Direct Cost: ¥1,000,000)
Fiscal Year 1998: ¥8,600,000 (Direct Cost: ¥8,600,000)
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| Keywords | Parkinson's disease / Deep brain stimulation / Globus pallidus internus / Subthalamic nucleus / Frozen gait / Local cerebral blood flow / SPECT / Microelectrode recording / 淡蒼球 / 術中微小電極記録 / PET / 三次元脳機能画像 |
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| Research Abstract |
It is well known that DBS of the posteroventral part of the medial pallidum (GPi) eliminates rigido-hypokinesia and dyskinesia but often shows a recurrence of gait freezing and wearing-off in Parkinson's disease. In the course of DBS surgery, we found a unilateral high-frequency stimulation of the middle-dorsal part of the GPi in the non-dominant hemisphere improved gait freezing postoperatively much longer than destructive surgery. DBS of the subthalamic nucleus alleviated hypokinesia and wearing-off, and could reduce levodopa dose as a result drug-induced dyskinesia decreased in some cases. Unilateral DBS of the STN usually showed a recurrence of the symptoms around three months after surgery and bilateral DBS needed to obtain good results in long postoperative days.
Microrecording disclosed an excessive high backgroud activitiy in the STN as well as the GPi, offering a useful study to delineate the surgical targets. Intraoperative injection of levodopa (1mg/kg, i.v.) decreased the background activity in the GPi 30-40% of the pre-injection state, however, did not change those of the GPe and STN.This suggests that the D2-mediated indirect pathway in the lenticular nucleus is hard to be modified by dopamine and so clinical importance of DBS of the STN which composes the indirect pathway.
Neuroimaging studies using SPECT revealed that a selective increase of CBF in the pre-SMA in bilateral hemispheres was induced by stimulation of the middle-dorsal GPi on the right side, and a CBF increase in the broad area of both hemispheres including the high convexity of the frontal lobe, anterior half of the medial cortex, thalamus and lenticular nucleus was produced by STN stimulation on the right.
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