Двусторонняя глубокая стимуляция задневентролатеральной области таламуса при тремор-ригидной форме болезни Паркинсона IV стадии с выраженными аксиальными нарушениями: клинический случай

Abstract

Background. Deep brain stimulation (DBS) is an established functional neurosurgical treatment for carefully selected patients with advanced Parkinson disease (PD). Clinical outcome depends on target selection, electrode localization, stimulation parameters, phenotype, and the severity of axial manifestations. Case Report. We describe a 44-year-old man with an approximately 17-year history of tremor-rigid PD with a prominent postural-kinetic component. His neurological phenotype included severe limb tremor, hypokinesia, muscular rigidity, hypomimia, freezing of gait, propulsion, retropulsion, lateropulsion, impaired balance, and recurrent falls. Disease severity corresponded to Hoehn–Yahr stage IV, with a Karnofsky Performance Status of 70. On August 28, 2025, bilateral frame-based DBS of the posterior ventrolateral thalamic region was performed using a Zamorano–Duchovny stereotactic system, MSCT-based registration, Medtronic DBS navigation, and intraoperative C-arm verification. The intracranial leads were connected to a subcutaneous implantable pulse generator placed in the right upper chest. Postoperative management included individualized stimulation programming, pharmacological adjustment, gait and balance rehabilitation, and longitudinal assessment using MDS-UPDRS, PDQ-39, MoCA, Berg Balance Scale, Timed Up and Go, and the Freezing of Gait Questionnaire. Conclusion. Bilateral motor thalamic DBS may provide substantial tremor suppression in advanced tremor-rigid PD. In patients with prominent axial dysfunction, however, optimal outcome requires a multimodal strategy integrating stereotactic accuracy, individualized programming, medication adjustment, and structured neurorehabilitation.