ДВУСТОРОННЯЯ ГЛУБОКАЯ СТИМУЛЯЦИЯ ЗАДНЕВЕНТРОЛАТЕРАЛЬНОЙ ОБЛАСТИ ТАЛАМУСА ПРИ ТРЕМОРО-РИГИДНОЙ БОЛЕЗНИ ПАРКИНСОНА IV СТАДИИ: ДИССОЦИАЦИЯ МЕЖДУ КОНТРОЛЕМ ТРЕМОРА И ВОССТАНОВЛЕНИЕМ АКСИАЛЬНЫХ ФУНКЦИЙ

Abstract

Background. Deep brain stimulation (DBS) is an established functional neurosurgical treatment for selected patients with Parkinson disease (PD) whose disabling tremor or motor complications remain insufficiently controlled by optimized pharmacological treatment. Clinical outcome depends substantially on matching the DBS target to the predominant motor phenotype.

Case Report. We describe a patient born in 1975 with PD since 2017. The clinical phenotype consisted of severe bilateral tremor, hypokinesia, muscular rigidity, hypomimia, plastic hypertonia, freezing of gait, short-step robotic gait, propulsion, lateropulsion, retropulsion, impaired balance, and recurrent falls. Disease severity corresponded to Hoehn–Yahr stage IV. Despite levodopa-based therapy and amantadine, progressive motor disability persisted. On June 3, 2025, bilateral frame-based DBS targeting the posterior ventrolateral thalamic region was performed using a Zamorano–Duchovny stereotactic system, stereotactic MSCT registration, Medtronic DBS navigation, and intraoperative C-arm verification. Postoperative stimulation produced marked tremor suppression but more moderate improvement in rigidity, bradykinesia, freezing of gait, and postural stability. At 12 months, multidomain assessment demonstrated a marked reduction in the tremor component with clinically meaningful but incomplete improvement in functional mobility and activities of daily living.

Conclusions. Bilateral motor thalamic DBS may provide substantial tremor control in advanced tremor-rigid PD. Severe baseline axial dysfunction requires realistic therapeutic expectations, individualized programming, and structured postoperative gait and balance rehabilitation.