丘脑底核电刺激对帕金森病患者抑郁的疗效及抑郁与其他症状改善程度的相关性研究

目的探讨丘脑底核电刺激(STN-DBS)对帕金森病(PD)患者抑郁的疗效,并观察其与其他症状改善程度的相关性。方法对70例接受STN-DBS治疗的PD患者进行术前评估及12个月以上追踪,采用统一PD评定量表第三部分(UPDRSⅢ)、39项PD调查表(PDQ-39)、汉密尔顿抑郁量表(HAMD)评估患者运动症状、生活质量及抑郁水平,并记录患者PD药物服用情况。结果 PD患者接受STN-DBS治疗1年以上,其运动症状明显改善,PD相关生活质量提高,PD相关药物用量降低(均P0.001)。HAMD总分及七类因子分在STN-DBS治疗1年后均显著下降(均P0.05)。PD患者HAMD总分的改善程度与UPDRSⅢ药物"关"期改善及PDQ-39评分改善呈正相关(均P0.05)。各类因子分别与其他疗效相关分析可见:焦虑/躯体化与UPDRSⅢ药物"关"期改善及PDQ-39评分改善呈正相关(均P0.05);体质量减轻与药物减量呈负相关(P0.05);认知障碍、睡眠障碍及绝望感分别与PDQ-39评分改善呈正相关(均P0.001);阻滞与UPDRSⅢ药物"开"、"关"期改善及PDQ-39评分改善分别呈正相关(均P0.05);日夜变化与其他症状改善之间均无相关性。结论 STN-DBS治疗PD患者1年以上,可显著改善其抑郁障碍。且不同抑郁因子分的改善与生活质量、运动症状改善及药物减量间存在特异相关性。     

丘脑底核电刺激术对75岁以上帕金森病患者疗效

目的研究丘脑底核电刺激术(STN-DBS)对75岁以上帕金森病(PD)患者术后1年的疗效。方法选取2003年5月至2017年5月在我院接受STN-DBS治疗的10例75岁以上PD患者进行回顾性研究,分别于术前、术后3个月、6个月、12个月进行UPDRSⅢ及帕金森非运动评分。结果 10例患者术后随访1年,开机未服药与术前未服药状态相比,UPDRSⅢ、震颤、强直、迟缓及中轴症状评分均显著降低(P0.05)。术后1年帕金森患者非运动评分ADL、HAMD、PSQI评分显著降低(P0.05),MMSE、HAMA评分有所增加(P0.05)。结论STN-DBS能显著改善75岁以上PD患者的运动症状和部分非运动症状,提高患者生活质量,减少抗PD药物用量。但仍需长期随访以评价对高龄患者的疗效。     

脑深部电刺激治疗帕金森病的长期随访研究

目的长期随访一组采用双侧脑深部电刺激(DBS)丘脑底核(STN)的帕金森(PD)病人,为临床研究提供参考。方法 195例PD病人在我院接受了双侧STN-DBS手术。术中采用微电极记录STN的外放电信号,刺激电极测试病人症状改善情况及副反应阈值。分别在术前术后1年、3年和5年采用UPDRS评分评估PD病人"开/关"两种状态下的症状改善程度。结果术前对照,PD病人术后5年"关"状态运动评分改善率为60.3%;日常生活评分的改善率为54.2%。语言是运动评分中唯一没有改善的症状。异动症除外,术后1年"开"状态下运动评分没有显著改善。第1年和第5年"开"状态下运动迟缓、姿势障碍和步僵症状较术前均有加重。术后第5年异动症较术前明显改善。结论 PD病人双侧STN-DBS术后长期随访结果表明,"关"状态下运动评分和"开"状态下异动症均明显改善。术后第1年和第5年比较,行动迟缓、语言、姿势异常、步僵和认知功能的障碍均有加重。     

帕金森病脑深部电极植入术后程控参数与疗效相关性研究

目的分析丘脑底核-脑深部电刺激术(STN-DBS)治疗帕金森病的术后程控参数及效果,为帕金森病STN-DBS术后程控及术后管理提供参考。方法纳入2012~2018年就诊于新疆医科大学第一附属医院87例患者,应用UPDRS-Ⅲ评分UPDRS-II日常生活活动评分UPDRS-I精神行为情绪评分量表MMSE简易精神量表PDQ-39生活质量评分量表分析手术前后帕金森病患者运动及非运动症状改善情况,评估程控参数的设置对帕金森病人症状改善及生活质量改善作用。结果帕金森病患者与术前相比,患者术后UPDRSⅠ评分UPDRSⅠⅡ评分UPDRSⅢ评分UPDRSⅣ评分改善明显,手术后随访至今,患者症状改善稳定,生活质量明显提高。结论 STN-DBS是一种安全,有效治疗帕金森病的方法,并减少药物的剂量及药物所致副作用,术后程控是脑深部电极植入器治疗的重要一环。     

单纯影像定位与微电极辅助定位在帕金森病手术中的应用

目的 比较单纯影像定位与微电极辅助定位（MER）进行丘脑底核脑深部电刺激术（STN-DBS）治疗帕金森病（PD）的疗效。方法 回顾性分析2017年1月至2019年12月STN-DBS治疗的112例PD的临床资料。70例通过单纯影像定位（影像组）,42例通过MER辅助定位（MER组）。术前与术后3个月,进行“关”状态下统一帕金森病评定量表（UPDRS）运动部分（Ⅲ）评分评估疗效,症状改善率=（术前评分-术后评分）/术前评分×100%。结果 影像组手术时间[（125±17）min]较MER组[（158±23）min]明显缩短（P<0.05）。两组电极尖端位置、术后3个月刺激参数（电压、频率、脉宽）均无统计学差异（P>0.05）。与术前药物“关”状态基线数据相比,术后3个月药物“关”状态DBS开启时,两组运动功能评分无统计学差异（P>0.05）。影像组运动功能评分改善率（56.3%）、震颤症状改善改善率（79.5%）、僵直症状改善率（57.9%）、运动迟缓评分改善率（44.8%）与MER组（分别为56.4%、75.4%、60.9%、47.6%）均无统计学差异（P>0.05）。两组术后均未发生出血及感染。结论 对于 STN-DBS治疗PD,单纯影像学定位与MER辅助定位技术对脑深部电极埋置位置和运动症状改善无明显差异,但是单纯影像定位技术可以缩短手术时间。     

单侧丘脑底核电刺激治疗偏侧型帕金森病的长期疗效

目的评估单侧丘脑底核(STN)脑深部电刺激(DBS)治疗偏侧型帕金森病的长期疗效。方法回顾性分析23例偏侧型帕金森病病人的临床资料,均行单侧STN-DBS治疗,并分别于术前3~5 d、术后1年、术后5年以帕金森病统一评分量表(UPDRS)进行评估。结果术后5年,病人在刺激"关"状态下,UPDRSⅡ、Ⅲ和轴性症状评分较术前明显升高(P<0.05);而刺激"开"状态下,UPDRSⅡ、Ⅲ和轴性部分评分较同期刺激"关"状态分别降低37.37%、41.14%和26.91%。与术前比较,术后5年平均每日口服左旋多巴等效剂量降低24.92%,而异动时间和异动病残度分别增加52.63%和59.65%。本组未发生手术相关并发症,随访期间出现发声困难6例。结论对偏侧型帕金森病人,单侧STN-DBS是一种疗效持久的治疗方法。     

脑深部电刺激双侧丘脑底核对帕金森病"冻结足"的治疗作用

目的 探讨脑深部电刺激(DBS)双侧丘脑底核(STN)治疗帕金森病(PD)的冻结足(FOG)的临床效果.方法 对13例合并有冻结足的PD患者行双侧丘脑底核脑深部电刺激术,至少随访12个月.采用UPDRS运动评分(UPDRSⅢ)、UPDRS日常生活能力评分(UPDRSⅡ)及UPDRSⅡ中的第14项"Freezing"项目的评分(FOG),分别对患者进行术前1周、术后6个月、12个月在药物治疗"开、关"期的基础评分及随访期间刺激器开启时的评分,尤其是"Freezing"项目得分多少及变化.进行统计学分析.结果 术后13例PD患者运动功能症状改善良好,UPDRSⅢ、UPDRSⅡ评分下降显著(P＜0.01).在手术后的6、12个月,刺激器开启时患者"关"期的冻结足评分明显下降(P＜0.01),而"开"期的冻结足没有改善(P＞0.05).结论 STN-DBS能显著改善PD患者"关"期的冻结足,而对"开"期的冻结足没有显著影响.     

丘脑底核脑深部刺激术治疗帕金森病的手术方法和疗效分析

目的 总结帕金森病(PD)脑深部刺激术(DBS)治疗的手术方法和效果。方法 对25例帕金森病患者进行了丘脑底核DBS治疗,其中单侧17例,双侧8例。采用磁共振扫描结合微电极记录技术进行靶点定位。术后用UPDRS运动评分评价刺激效果。结果 25例PD患者术后随访5～34个月,平均8.3个月。脉冲发生器开启时,在“关”状态下,UPDRS运动评分改善率50.2％;在“开”状态下,UPDRS运动评分改善率20.7％,未发现任何并发症。结论 丘脑底核DBS是改善PD患者运动功能较为理想的治疗方法。     

帕金森病脑深部刺激治疗对认知和抑郁状态影响的队列研究

目的探讨帕金森病(PD)丘脑底核(STN)脑深部刺激治疗(DBS)对认知和抑郁状态的影响。方法连续的27例PD患者接受丘脑底核脑深部刺激治疗(STN-DBS)手术治疗,术前1周及术后6个月对认知和抑郁状态进行评估。结果术后6个月认知功能与术前认知、运动症状改善程度正相关。术后抑郁评分的改善程度与术前抑郁评分和运动症状改善程度正相关。结论在严格筛选手术适应证的前提下,STN-DBS可能对部分患者的认知功能有改善作用,并且不加重抑郁状态。     

脑深部电刺激治疗帕金森病的程控

目的探讨丘脑底核脑深部电刺激术治疗帕金森病(PD)的手术方法和脉冲发生器程控调节。方法自2000年1月～2004年2月用脑深部电刺激丘脑底核(STN)治疗帕金森病61例,其中单侧30例,双侧31例。采用磁共振扫描结合微电极记录技术进行靶点定位。术后用帕金森病评定量表(UPDRS)运动评分评价刺激效果。结果61例PD患者术后随访6～36个月,平均11．3个月。脉冲发生器开启时,在“关”状态下,UPDRS运动评分改善率45．2％;在“开”状态下,UPDRS运动评分改善率20．7％,未发现任何并发症。结论脑深部刺激(DBS)能有效控制帕金森病患者的症状,手术并发症少,术后可根据患者的症状调节参数,丘脑底核(STN)已成为治疗帕金森病的最佳靶点。     

Lack of motor symptoms progression in Parkinson's disease patients with long-term bilateral subthalamic deep brain stimulation

To evaluate the long-term progression of motor symptoms in Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS), we retrospectively analyzed data from 50 PD patients with bilateral STN-DBS. Clinical records at baseline and at several yearly intervals were reviewed. The Unified Parkinson's Disease Rating scale (UPDRS) was performed preoperatively after withholding medications for at least 12 hr (OFF) and after taking the usual dose of levodopa. Postoperative evaluations were completed in four clinical states: OFF medications—stimulators OFF (OFF/OFF); OFF medications—stimulators ON; ON medications—stimulators OFF; and ON medications—stimulators ON. The UPDRS motor scores OFF/OFF were virtually unmodified up to 5 years when compared with preoperative OFF scores. There was no significant difference between OFF/OFF score variations from baseline in patients with shorter (<11 years) and longer PD duration at the time of surgery. No consistent deterioration from untreated baseline was noted for each UPDRS motor subscore (tremor, rigidity, bradykinesia, and axial). Untreated PD motor scores did not worsen over time in patients undergoing STN-DBS, suggesting that there is no progression of motor severity. These results could be explained either by a natural stabilization of PD motor symptoms after many years or neuroprotective properties of STN-DBS.     

交叉电脉冲在帕金森病DBS后程控中的应用

目的 探讨交叉电脉冲（ILS）在帕金森病（PD）脑深部电刺激术（DBS）后传统刺激方式疗效不佳病人中的应用效果。方法 回顾性分析2018年2月至2021年10月丘脑底核（STN）-DBS治疗的12例PD的临床资料。12例DBS后应用传统刺激方式疗效不佳,使用ILS（时间>6个月）。使用ILS后随访6~12个月,采用统一帕金森病生活量表（UPDRS Ⅱ）评分、运动量表（UPDRS Ⅲ）评分、异动症量表（UPDRS Ⅳ-A）评分评估疗效及左旋多巴等效日剂量（LEDD）评价药物使用情况。结果 与ILS前（药物关期）相比,使用ILS后（药物关期）UPDRS-Ⅱ评分、UPDRS Ⅳ-A评分、UPDRS-Ⅲ评分总分均明显改善（P<0.05）,LEDD无明显变化（P>0.05）。结论 PD病人STN-DBS后,在传统刺激模式症状改善不佳或出现刺激副反应时,ILS可明显改善PD症状、减轻刺激相关副反应。     

丘脑底核脑深部电刺激对帕金森病抑郁障碍的影响

目的探讨丘脑底核脑深部电刺激对帕金森病病人抑郁障碍的疗效及其机制。方法回顾性分析21例帕金森病合并抑郁障碍病人的临床资料,均行丘脑底核脑深部电刺激术,术前及术后3、6个月分别应用汉密尔顿抑郁量表(HAMD)评分和统一帕金森病评定量表(UPDRS)运动评分对抑郁障碍和运动功能进行临床评价并分析其相关性。结果术后UPDRS运动评分和HAMD评分均显著下降(均P0.05),但是抑郁症状的改善与运动功能的改善并没有明显的相关性(P0.05)。结论丘脑底核脑深部电刺激能够明显改善帕金森病病人的抑郁症状,其机制可能与丘脑底核受到刺激影响脑内神经递质的变化有关,术后运动功能的改善不是抑郁症状改善的主要原因。     

微电极导向核团毁损术和脑深部电刺激术治疗帕金森病的疗效分析

目的 观察微电极导向核团毁损术和脑深部电刺激术（DBS）治疗帕金森病的临床疗效。方法 对380例接受微电极导向立体定向核团毁损术和25例脑深部电刺激丘脑底核（STN—DBS）治疗的帕金森病患者进行随访和神经功能评估，分别获得术前、术后和DBS开启后1周、6个月、2年及5年的不同服药状态下统一帕金森病量表（UPDRS）评分资料，采用威尔科克森检验（Wilcoxontest），比较不同术后时间点UPDRS运动评分与术前评分的差异。结果 核团毁损术和DBS在术后1周、6个月及2年随访中均能明显改善术前帕金森病患者的UPDRS运动评分，减轻左旋多巴诱发的运动波动及异动症。在5年随访时间点上仅DBS治疗组较术前比较仍显示差异性。而且DBS组患者术后左旋多巴服药的剂量较术前减少。核团毁损组总体并发症的发生率为5．8％，永久性并发症的发生率为1．2％。DBS组未发生严重并发症。结论 核团毁损术和DBS两者被证实是中晚期帕金森病安全、有效的治疗方法，能显著改善术前帕金森病患者的UPDRS运动评分，减轻左旋多巴诱发的运动波动及异动症。STN—DBS较毁损术更具有独特的可控性、安全性和长效性。     

丘脑底核脑深部电刺激治疗帕金森病合并抑郁障碍的长期疗效

目的研究丘脑底核（STN）脑深部电刺激（DBS）治疗帕金森病（PD）合并抑郁障碍的长期疗效并探讨其神经机制。方法对15例合并抑郁障碍的PD患者实施STN脑深部电极植入，术后3个月、6个月和12个月进行随访和临床评价。结果术后运动功能症状如肢体僵硬、震颤、运动迟缓和姿势平衡障碍改善良好，停药后PD分级量表运动评分显著下降（P〈0．01）。术后抑郁障碍症状如焦虑、绝望和激越症状改善良好，停药后汉密尔顿抑郁量表评分显著下降（P〈0．05）。结论STN-DBS能显著改善PD的抑郁障碍症状，STN在PD抑郁障碍神经机制中起重要作用。     

丘脑底核电刺激治疗苍白球毁损术后的帕金森病(12例报告)

目的探讨帕金森病(Parkinson's disease,PD)苍白球腹后部毁损术(posteroventral pallidotomy,PVP)后再行丘脑底核(subthalamic nucleus,STN)脑深部电刺激术(deep brain stimulation,DBS)的可行性、术中电生理学特点和治疗结果。方法应用MR和微电极记录技术进行靶点定位,对12例单侧PVP术后症状再次加重的PD患者实施STN-DBS手术,其中4例行毁损灶对侧的STN-DBS,8例行双侧STN-DBS。结果STN-DBS对本组12例PD患者症状有不同程度的改善,双侧STN-DBS的效果尤为明显,术后3个月的UPDRS运动及ADL评分较术前明显减少(P<0．05或0．01),美多巴的用量明显减少(P<0．01),无明显术后并发症。术中电生理记录显示毁损灶同侧的细胞放电明显低于正常情况。结论曾行单侧PVP的PD患者如面临二次手术,可以选择DBS手术,以双侧STN的DBS效果最好,可减少药物用量。     

Psychiatric Symptoms and Subthalamic Nucleus Stimulation in Parkinson's Disease. A Retrospective Study in Our Japanese Patients

Objectives. With respect to postoperative activities of daily living (ADL), we retrospectively investigated associated psychiatric symptoms that influenced beneficial effects of subthalamic nucleus (STN) stimulation in our Japanese patients with Parkinson disease (PD). Materials and Methods. Twenty‐five patients underwent bilateral STN stimulation. Pre‐ and 3 months after the surgery, their parkinsonian symptoms were evaluated with Unified Parkinson Disease Rating Scale (UPDRS) and Schwab‐England (S‐E) ADL scale. Stepwise multiple analysis was performed to determine the factors affecting postoperative ADL. Results. Eleven out of 25 patients manifested drug‐induced psychosis preoperatively, although their mean dosage of levodopa was small (366.4 ± 152.7 mg). Disease duration positively affected the severity of the patients’ psychiatric symptoms. Postoperative S‐E score showed a significant improvement compared to the pretreatment baseline in both of “on” and “off” medication states, as all their cardinal motor symptoms were significantly ameliorated. Preoperative scores for thought disorder and axial disability negatively impact on the postoperative S‐E score in “on” state (p < 0.01). Preoperative score for intellectual impairment was only a significant predictor of worse postoperative ADL in “off” state. Conclusions. The markedly lower dose of levodopa may suggest ethnic characteristics of our Japanese patients with respect to tolerance for antiparkinsonian medications. Preoperative manifestation of drug‐induced psychosis and cognitive dysfunction were the major factor that strikingly suppressed daily activities after STN stimulation.     

An investigation into the effects and prognostic factors of cognitive decline following subthalamic nucleus stimulation in patients with Parkinson’s disease

We retrospectively investigated the effects of subthalamic nucleus stimulation (STN-DBS) on new postoperative onset of cognitive decline and prognostic factors for advanced Parkinson’s disease (PD). We studied 39 PD patients who had received bilateral STN-DBS. Clinical symptoms, cognitive function, psychiatric function, and health-related quality of life (HRQOL) were assessed before and six months after surgery. Based on the results of neuropsychological examinations six months after the surgery, the subjects were divided into those with and those without cognitive decline. We compared pre- and post-operative assessments between the two groups. Prognostic factors were investigated using multiple logistic regression analyses. Seven patients had cognitive decline six months after the operation (17.9%); they were significantly older than those without cognitive decline. Preoperative neuropsychological examinations revealed impairments in language and executive function. No differences were found in clinical symptoms. Patients with cognitive decline had significantly worse apathy scale scores. The HRQOL revealed significant declines in the Mental Component Summary (MCS), vitality, and mental health (MH) domains. Postoperative comparisons revealed novel significant differences in activities of daily living in the “on” and “off” states and in daytime drowsiness. Preoperative differences seen in the MCS and vitality indices were no longer present. Word fluency, and apathy scale and MH scores were independent preoperative prognostic factors for cognitive decline. New postoperative onset of cognitive decline due to STN-DBS affected activities of daily living and psychiatric function. Preoperative non-motor symptoms may be prognostic factors for new onset of cognitive decline.     

双侧丘脑底核电刺激对帕金森病患者生活质量影响的研究

目的对给予丘脑底核(STN)电刺激治疗的帕金森病(PD)患者进行生活质量评估,以评价治疗的有效性及不同因素对生活质量的影响。方法41例接受双侧STN深部电刺激(DBS)治疗的PD患者分别于术前及术后12个月应用统一帕金森病评定量表(UPDRS)、Hoehn和Yahr分期、Schwab和England日常生活活动量表、医院焦虑和抑郁量表(HADS)评价其临床情况;帕金森病生活质量问卷(PDQ-39)评价生活质量,并对统计结果进行配对t检验和Spearman相关性检验。结果UPDRS评分中日常生活活动、运动检查、并发症均有明显改善(P<0.001),而精神、行为和情绪无明显改善。HADS量表结果显示患者的焦虑及抑郁评分均有明显改善(P<0.001)。PDQ-39评分中运动、日常生活活动、情绪状态、身体不适、总评分等项均有明显改善(P<0.001),羞耻感也有改善(P<0.05)。相关性检验的结果提示与PDQ-39总评分变化程度成相关性的因素依次为:UPDRS运动检查“关”期(P<0.001), Schwab和England日常生活活动量表“关”期(P<0.001),UPDRS日常生活活动“关”期(P<0.01),HADS-抑郁(P< 0.05)。结论脑深部电刺激能明显改善PD患者的生活质量。     

Bilateral subthalamic stimulation monotherapy in advanced Parkinson's disease: long-term follow-up of patients.

Bilateral subthalamic nucleus stimulation (STN-DBS) is used to improve parkinsonian symptoms and attenuate levodopa-induced motor complications. In some patients, such clinical improvement allows antiparkinsonian medication (ApMed) withdrawal. We show the clinical outcome at the long-term follow-up of patients with advanced Parkinson's disease (PD) in which STN-DBS was used in monotherapy, and compare the clinical results of patients without medication with those obtained in parkinsonian patients in which ApMed were reduced but could not be totally displaced after surgery. We analyzed clinical outcome of ten patients with PD in which all ApMed was withdrawn after bilateral subthalamic stimulation and 16 parkinsonian patients still taking antiparkinsonian medication after surgery. After 1.5 years, STN-DBS monotherapy produced UPDRS motor scores similar to those observed in the on-drug condition before surgery without the inconvenience of motor fluctuations and dyskinesias. No significant differences were seen in most of clinical outcome measures when comparing patients still taking ApMed with patients in STN-DBS monotherapy but a few patients still taking ApMed presented mild dyskinesias and motor fluctuations and patients with STN-DBS monotherapy did not. STN-DBS is useful in the treatment of advanced PD and in some patients it is possible to maintain this therapy alone in the long term. The therapeutic effect of STN-DBS on motor signs can be equipotent to that of levodopa with the additional benefit of avoiding motor fluctuations and dyskinesias.