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1.
目的分析丘脑底核-脑深部电刺激术(STN-DBS)治疗帕金森病患者的术后程控工作及相关情况,为STN-DBS术后刺激参数的设置、药物的调整提供参考依据。方法病例选自2005年3月至2006年12月在北京天坛医院接受双侧STN-DBS植入术治疗的57例帕金森病患者。分析手术前后药物的用量和调整情况,评估不同刺激参数对震颤、运动徐缓和僵直等PD运动症状的改善作用。结果与术前相比PD患者DBS术后服用多巴胺类药物的剂量明显减少,术前平均707.59mg,术后平均253.62mg,平均减少63%,其中8例不再服用左旋多巴类药物。刺激频率为10Hz时无治疗作用,130Hz以上时症状可得到显著改善。除3例发生对侧肢体痉挛性收缩外,频率达到185Hz时能够获得最佳治疗效果。电压为2V-3V时可较好的改善运动,并随着电压值的增加治疗作用逐渐增强。结论本研究证实STN-DBS是一种安全、有效的治疗帕金森病的方法,STN-DBS能够显著减少左旋多巴类药物用量及药物引起的异动症、运动波动等并发症的发生。刺激电压是术后程控的主要调节参数。  相似文献   

2.
目的 探讨帕金森病丘脑底核深部脑刺激(DBS)术后脉冲发生器的参数调整.方法 回顾性分析117例帕金森病病人的临床资料,均行丘脑底核DBS,单侧电极植入45例,双侧电极植入72例;并记录术后刺激参数的调整.结果 刺激参数:双极刺激电压1-4 V,单极刺激电压1-3.6 V;脉宽60-90 μs;频率130 Hz.统一帕金森病评定量表(UPDRS)运动评分的改善率,双侧刺激较单侧刺激明显(P<0.05).治疗后1-6个月,抗帕金森药物用量减少78例(66.7%),维持术前水平39例(33.3%).结论 帕金森病丘脑底核DBS术后采用适当刺激参数可获得安全、可靠的疗效;电压调整对帕金森症状控制作用明显,脉宽及频率调整相对较少;双侧刺激效果优于单侧.  相似文献   

3.
目的探讨大脑脚间核脑深部电刺激对帕金森病冻结步态的改善效果。方法采用大脑脚间核脑深部电刺激(DBS)术治疗3例药物难治性冻结步态帕金森病患者。其中2例患者采用双侧大脑脚间核DBS,1例患者采用单侧大脑脚间核联合对侧丘脑底核DBS。采用UPDRSⅢ(27~30项)对患者的轴线症状进行评分,评估效果。结果术后2例双侧DBS术的患者改善率为63.6%和66.7%;单侧DBS术患者的改善率为57.1%。3例患者术后无明显并发症。结论大脑脚间核DBS术对药物难治性帕金森病冻结步态是一种安全有效的治疗方式。  相似文献   

4.
脑深部电刺激治疗运动障碍性疾病   总被引:8,自引:0,他引:8  
目的探讨脑深部电刺激(DBS)对帕金森病(PD)和肌张力障碍(dystonia)等运动障碍性疾病的治疗作用及手术方法。方法应用3.0TMRI和微电极导向技术及手术计划系统进行靶点定位,对40例PD病人和3例继发性肌张力障碍病人进行双侧丘脑底核(STN)电极植入。结果PD病人的主要症状有显著改善,服药量也明显减少,术前和术后UPDRS评分有显著差异;3例继发性肌张力障碍病人症状均有不同程度的改善,如以UDRS和BFMS作为评价指标,其中1例药物引起的迟发性肌张力障碍病人症状改善达90%以上;术后无严重及永久并发症。结论首次证实STN-DBS对继发性肌张力障碍是一种有效的治疗方法,双侧STN-DBS是外科治疗PD的首选方法,DBS对运动障碍性疾病的治疗已显示出良好的前景。  相似文献   

5.
脑深部刺激电极埋置术治疗帕金森病疗效研究   总被引:2,自引:2,他引:0  
目的 探讨脑深部刺激电极埋置术治疗帕金森病的疗效及其作用机制。方法 对32例帕金森病患者应用微电极导向立体定向技术,于丘脑底核埋置体外可控性脑深部刺激电极,对其疗效和预后进行随访。结果患者术后僵硬、震颤和运动迟缓等症状明显缓解,术前、术后统一帕金森病评分量表(unified Parkinson's disease ratingscale,UPDRS)运动评分和日常生活能力(activities of daily living,ADL)评分有显著性差异(P<0.01),部分患者由药物引起的开-关现象也有明显缓解;协同服用的多巴胺类药物的用量也有不同程度的减少。所有患者术中及术后均无严重的并发症,术后随访疗效肯定。结论 丘脑底核放置深部脑刺激电极,能明显改善帕金森病患者的临床症状,提高手术的安全性,并发症少。  相似文献   

6.
丘脑底核与电刺激术效果关系的研究   总被引:11,自引:3,他引:8  
目的 研究脑深部电刺激(DBS)对帕金森病(PD)的治疗作用,观察术中丘脑底核(STN)刺激对PD震颤、肌僵直、运动的缓解效果以及对语言的影响,探讨电极在丘脑底核内的解剖位置与刺激效果的关系,以寻找植入刺激电极至STN的最佳位置。方法 26例帕金森病患者,利用MRI及微电极导向立体定向方法将刺激电极植入丘脑底核,其靶点:X=11mm-13mm,Y=-1mm--3mm,Z=-7mm。术中予以高频刺激(频率为130Hz-150Hz,脉宽为90μs-150μs,电压自0.5V开始,逐渐增至8V);利用电极的不同触点分别进行刺激,根据刺激效果和副反应的出现情况,确定电极在STN中的最佳位置。其中有3例进行了STN电极永久性植入,术后随访6-14月。结果 26例术中刺激发现,STN背外侧部是电刺激的最佳位置,而电极过深及过外铡易引起言语障碍。结论 STN的高频刺激能改善PD的震颤、僵直、运动缓慢等主要症状,是PD慢性刺激的最理想靶点,其背外侧部是刺激效果的最佳位置。  相似文献   

7.
丘脑底核电刺激治疗帕金森病   总被引:12,自引:4,他引:8  
目的 探讨脑深部电刺激(DBS)对原发帕金森病(PD)的治疗作用及手术方法。方法 应用微电极导向技术和手术计划系统进行靶点定位,对20例PD病人的丘脑底核(STN)进行电极植入,术后至少6个月的评价和随访。结果 15例单侧和5例双侧STN的DBS术后病人肢体僵直、震颤和运动迟缓等症状改善明显,术前术后UPDRS运动评分和日常生活能力评分均有显著下降(P<0.01),服药量也有不同程度的减少,无严重及永久并发症。结论 STN的DBS手术治疗PD,对症状改善非常全面,可通过参数调整达到最佳治疗效果。服药量明显减少,是一种安全、有效的治疗方法。  相似文献   

8.
目的分别应用脑深部电刺激(deepbrainstimulation,DBS)和苍白球毁损术(posteroventralpallidot-omy,PVP)治疗原发性帕金森病(Parkinson'sdisease,PD),对照研究DBS和PVP对PD患者的震颤、肢体僵硬、运动迟缓的疗效。方法应用CT影像学与微电极电生理定位结合的方法进行靶点定位,为11例帕金森病患者进行同期双侧丘脑底核电极植入,26例患者进行分期双侧苍白球腹后部毁损术,经过至少6个月的随访并行UPDRS评分。结果11例同期进行双侧丘脑底核电极植入及26例分期进行双侧苍白球毁腹后部毁损术患者术后的震颤、肢体僵硬、运动迟缓症状均不同程度的改善,但以DBS手术的改善程度更为明显,两组患者手术前后的UPDRS评分下降程度差异显著(P<0.05)。结论双侧同期DBS是目前治疗PD相对较好的方法,双侧电极植入在改善肢体症状的同时可以明显控制、改善中轴症状,在治疗中晚期PD患者方面较PVP有较大的优势。  相似文献   

9.
目的 观察帕金森病(PD)病人丘脑底核脑深部电刺激(STN—DBS)术后药物变化情况。探讨STN—DBS对帕金森病术后药物治疗的影响。方法 对接受STN—DBS手术治疗的40例帕金森病病人手术前后的药物服用剂量、药物引起的相关并发症等情况进行回顾性分析。结果 本组经6~49个月随访。多数病人在STN-DBS作用下因症状明显改善,于开机后的1-6个月间使用抗PD药物逐渐减量。最终的选择剂量可维持2年以上。开机后5例不再服用相关药物。25例药物较术前平均减少60%。7例药物用量与术前相同,3例行单侧STN—DBS者术后药物用量增加。药物相关并发症因术后药物用量的减少而得到明显缓解。结论 STN—DBS能够减少术后抗PD药物的用量。改善药物引起的相关并发症。  相似文献   

10.
目的通过丘脑底核(STN)脑深部高频电刺激(DBS)治疗的11例帕金森病(PD)患者手术前后情况对比,初步探讨其近期的疗效和安全性。方法本院2013年7月至2014年9月STN-DBS治疗的11例(双侧9例,单侧2例)原发性PD患者,采用MRI、微电极记录(MER)技术和术中测试共同确定靶点,同期植入脉冲发生器,术后复查头颅CT,分别在术前、术后未开机第3天、开机后3月、6月、12月和15月采用UPDRS评分评估PD患者"开/关"两种状态下的运动症状改善程度、运动并发症、嗅觉改善和左旋多巴类药物减少情况。结果电极植入靶点均为STN,术后早期全部出现微毁损效应,1侧出现电极移位,1例有一过性复视,无硬件相关并发症,开机后12个月时程控参数达到稳定,症状改善达到最优,以震颤(达84.8%)、僵直改善最为明显,平衡障碍改善最差(为49.8%)。结论丘脑底核高频电刺激治疗PD近期疗效显著,术后并发症少。  相似文献   

11.
We report on 6 advanced Parkinson's disease (PD) patients who underwent bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery whose restless legs syndrome (RLS) improved postoperatively. Despite a mean 56% decrease in their levodopa equivalents postoperatively, their RLS scores dropped by a mean of 84% (100% in three). Our findings suggest that bilateral STN DBS surgery can improve RLS in patients with advanced PD.  相似文献   

12.
双侧丘脑底核电刺激对帕金森病患者脑局部糖代谢的影响   总被引:1,自引:1,他引:0  
目的 研究双侧丘脑底核(subthalamic nucleus,STN)慢性电刺激术(deep brain stimulation,DBS)对晚期帕金森病(Parkinson's disease,PD)患者静止期脑局部糖代谢的影响,并探讨其作用机制。方法 对5例进行双侧STN的DBS治疗的晚期帕金森病患者,分别在术前以及术后1个月电刺激条件下,进行静止期18F-脱氧葡萄糖(FDG)/PET检查和UPDRS运动评分,并通过SPM99统计学软件进行数据分析,比较STN的DBS治疗对脑内代谢的影响。结果 双侧STN的DBS治疗使PD患者临床症状明显改善,同时脑局部糖代谢也发生了明显变化:双侧豆状核、脑干(中脑、脑桥)、双侧顶枕部、运动前区(BA6)及扣带回的脑代谢增加,双侧前额叶底部海马的脑代谢明显减少(P<0.05)。结论 双侧STN的DBS治疗可能通过兴奋STN轴突的方式,使其投射区域的基底上行和下行通路以及相应的皮层高级中枢的代谢改善,从而使PD患者的临床症状改善。  相似文献   

13.
OBJECTIVE: We investigated the effect of bilateral subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on intracortical inhibition (ICI) in patients with advanced Parkinson's disease (PD). METHODS: The activity of intracortical inhibitory circuits was studied in 4 PD patients implanted with stimulating electrodes both in STN and GPi by means of paired-pulse transcranial magnetic stimulation, delivered in a conditioning-test design at short (1-6 ms) interstimulus intervals (ISI). The effect of apomorphine on the same PD patients was also investigated. RESULTS: We observed that implanted PD patients showed a significant increase in ICI during either bilateral STN or GPi DBS at 3 ms ISI, and during bilateral STN DBS at 2 ms ISI in comparison to their off DBS condition. The same statistical improvement was observed during apomorphine infusion at 3 and 2 ms ISI. In each condition, the electrophysiological changes were associated with a significant clinical improvement as measured by the Unified Parkinson's Disease Rating Scale motor examination. CONCLUSIONS: These results are consistent with the hypothesis that basal ganglia DBS can mimic the effects of pharmacological dopaminergic therapy on PD patients cortical activity. We propose that in PD patients, the basal ganglia DBS-induced improvement of ICI may be related to a recovery in modulation of thalamo-cortical motor pathway.  相似文献   

14.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for the motor symptoms of advanced Parkinson's disease (PD). The aim of this study was to assess the effect of the bilateral surgical procedure and STN DBS on the neuropsychological functions. Twenty Parkinson's disease patients underwent a neuropsychological assessment before and 6 months after surgery in four different conditions: medication on (with levodopa) and medication off (without levodopa) during the preoperative period, medication on/stimulation on (levodopa plus stimulators switched on) and medication off/stimulation on (stimulators switched on without levodopa) during the postoperative period. We did not find any significant difference in the four conditions for all the neuropsychological tests, confirming the lack of an overall cognitive decline after surgery. From a neuropsychological point of view, these results seem to indicate that bilateral STN DBS is a safe treatment for advanced PD.  相似文献   

15.
We selected 14 patients with advanced idiopathic Parkinson's disease (PD) and examined the clinical effects of STN DBS versus GPi DBS. Nine patients underwent bilateral STN DBS and five underwent bilateral GPi patients. All patients were followed for at least 12 months. The evaluation was performed on and off drug before surgery; on-drug/on-DBS and off-drug/on-DBS at 1, 2, 6 and 12 months after stereotactic surgery. At 1 and 3 months after surgery in off-drug/on-DBS condition, both groups showed an improvement in motor score (UPDRS II). Nevertheless, the results changed after long-term stimulation in the two groups. Chronic STN DBS is superior to GPi DBS in the amelioration of the clinical features and in the decrease of time spent in the off state. The efficacy in reduction of LID was comparable at 1 and 3 months after surgery, but the results were better in STN DBS after chronic stimulation. The L-dopa dose was reduced only in the STN group.  相似文献   

16.
Subthalamic (STN) deep brain stimulation (DBS) is an effective treatment for advanced Parkinson's disease. We present a patient with significant gait problems due to Parkinson's disease (PD) who underwent STN DBS. Gait worsened after surgery despite significant improvement in parkinsonian signs, due to underlying spasticity previously overshadowed by his parkinsonian motor symptoms. This case illustrates an emergence of dysfunction in gait in a patient with otherwise improved function and reinforces the need for an interdisciplinary approach to care of these patients.  相似文献   

17.
We report a patient with advanced Parkinson's disease (PD) who developed a recurrence of major depression with psychotic features after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. Electroconvulsive therapy (ECT) dramatically improved the depression without shifting electrode position or damaging the DBS hardware. This case suggests that ECT can be a safe and effective option for severe depression in PD patients treated with STN DBS.  相似文献   

18.
R Kumar  A M Lozano  E Sime  E Halket  A E Lang 《Neurology》1999,53(3):561-566
OBJECTIVE: To compare the effects of unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) with bilateral STN DBS in advanced PD. METHODS: Our initial 10 consecutive patients with medication-refractory motor fluctuations and levodopa-induced dyskinesias undergoing chronic bilateral STN DBS underwent a standardized evaluation of unilateral and bilateral STN DBS in the medication-off state 6 to 18 months after electrode implantation. RESULTS: Bilateral STN DBS improved the mean total Unified Parkinson's Disease Rating Scale motor score by 54%, whereas unilateral stimulation improved motor scores only 23%. Unilateral STN DBS improved postural stability and gait 14%, other axial motor features 19%, and overall parkinsonism in limbs contralateral to stimulation by 46%, including an 86% improvement in contralateral tremor. However, bilateral STN DBS resulted in greater improvement in each of these domains, including limb function, i.e., the reduction in scores from the limbs on one side was greater with bilateral than with unilateral stimulation of the contralateral STN. CONCLUSIONS: Bilateral STN DBS improves parkinsonism considerably more than unilateral STN DBS; bilateral simultaneous electrode implantation may be the most appropriate surgical option for patients with significant bilateral disability. Unilateral STN DBS results in moderate improvement in all aspects of off-period parkinsonism and improves tremor as much as is typically reported with DBS of the ventral intermedius nucleus of the thalamus (Vim). For this reason, STN DBS may be a more appropriate choice than Vim DBS or thalamotomy for parkinsonian tremor. Some patients with highly asymmetric tremor-dominant PD might be appropriately treated with unilateral instead of bilateral STN DBS.  相似文献   

19.
BACKGROUND: Deep brain stimulation (DBS) of the globus pallidus interna (GPi) and subthalamic nucleus (STN) has been reported to relieve motor symptoms and levodopa-induced dyskinesia in patients with advanced Parkinson disease (PD). Although it has been suggested that stimulation of the STN may be superior to stimulation of the GPi, comparative trials are limited. OBJECTIVE: To extend our randomized, blinded pilot comparison of the safety and efficacy of STN and GPi stimulation in patients with advanced PD. DESIGN: This study represents the combined results from our previously published, randomized, blinded, parallel-group pilot study and additional patients enrolled in our single-center extension study. SETTING: Oregon Health and Science University in Portland.Patients Twenty-three patients with idiopathic PD, levodopa-induced dyskinesia, and response fluctuations were randomized to implantation of bilateral GPi or STN stimulators. Patients and evaluating clinicians were blinded to stimulation site. All patients were tested preoperatively while taking and not taking medications and after 3, 6, and 12 months of DBS. MAIN OUTCOME MEASURES: Postoperatively, response of symptoms to DBS, medication, and combined medication and DBS was evaluated. Twenty patients (10 in the GPi group and 10 in the STN group) completed 12-month follow-up. RESULTS: Off-medication Unified Parkinson's Disease Rating Scale motor scores were improved after 12 months of both GPi and STN stimulation (39% vs 48%). Bradykinesia tended to improve more with STN than GPi stimulation. No improvement in on-medication function was observed in either group. Levodopa dose was reduced by 38% in STN stimulation patients compared with 3% in GPi stimulation patients (P = .08). Dyskinesia was reduced by stimulation at both GPi and STN (89% vs 62%). Cognitive and behavioral complications were observed only in combination with STN stimulation. CONCLUSION: Stimulation of either the GPi or STN improves many features of advanced PD. It is premature to exclude GPi as an appropriate target for DBS in patients with advanced disease.  相似文献   

20.
Parkinson's disease (PD) is a common neurological disorder. Recently, bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an option in the treatment of severe PD. We measured the health-related quality of life (HRQoL) of 27 parkinsonian patients, who underwent a bilateral STN-operation. The instruments used for the evaluation of the HRQoL were the Parkinson's Disease Questionnaire (PDQ-39) and the Finnish version of the Nottingham Health Profile (NHP). We found that the quality of life significantly improved when measured with both HRQoL scales. Clinical improvement and improvement in HRQoL were positively correlated.  相似文献   

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