Двусторонняя глубокая стимуляция задневентролатеральной области таламуса при тремор-ригидной форме болезни Паркинсона IV стадии: клинический случай с мультимодальной оценкой

Abstract

Background. Deep brain stimulation (DBS) is an established functional stereotactic neurosurgical treatment for selected patients with Parkinson disease (PD) who have disabling tremor, rigidity, bradykinesia, motor fluctuations, or insufficient symptom control despite pharmacotherapy. We report a male patient born in 1969 with symptom onset in 2016 and a tremor-rigid PD phenotype classified as Hoehn–Yahr stage IV. Case Report. At admission, the predominant manifestations included persistent upper-limb tremor, hypokinesia, muscular rigidity, hypomimia, freezing of gait, propulsion, retropulsion, lateropulsion, postural instability with falls, lower-limb weakness, and autonomic dysfunction. Despite ongoing antiparkinsonian therapy, the symptoms progressed. On August 28, 2025, bilateral frame-based DBS was performed using a Zamorano–Duchovny stereotactic system (Inomed, Germany), stereotactic multislice CT, Medtronic DICOM-based navigation, and intraoperative C-arm verification. According to the operative record, the electrodes were implanted into the posterior ventrolateral thalamic region. The implantable pulse generator was positioned in the right upper chest. Conclusion. This case illustrates the value of individualized stereotactic planning in advanced tremor-rigid PD and the importance of separately quantifying tremor suppression, rigidity, bradykinesia, gait, balance, and functional independence. Missing standardized scale and programming values in this working manuscript are explicitly marked as simulated and must be replaced with actual patient measurements before scientific submission.