脳卒中後不随意運動の脳内植込み電極と体内埋設刺激ディバイスによる制御

Abstract

Involuntary movements are not uncommon consequences of stroke, which limit patients' daily activity greatly. Ablative neurosurgical procedures, such as thalamotomy and pallidotomy, for control of involuntary movements always carry a risk associated with creating additional lesions in an already damaged brain, and the results of these procedures are not always satisfactory. Due to the unpredictability of the effects and the irreversibility of the procedures, most physicians have been reluctant to recommend ablative neurosurgical treatments to their patients whose brain is already damaged by stroke. In contrast, there is not such a risk in deep brain stimulation (DBS) therapy. Based on our experience with 25 patients with post-stroke involuntary movements, clinical values of DBS are summarized. A quadripolar DBS electrode is placed in such a way that the most distal contact is located on the ventral part of thalamic VIM nucleus and the most proximal contact in the dorsal part of VOP nucleus. Complete control of involuntary movements has been achieved by DBS in many patients (76%) with hemiballism, hemichoreo-athetosis, jerky dystonic unsteady hand, distal resting and/or action tremor and proximal postural tremor. The effects have continued to be seen for the entire follow-up period ranging 1-9 years in our series. DBS is an ideal therapeutic option to control post-stroke involuntary movements due to the reversibility of the procedure, and alterability of anatomical location and extent of stimulation.