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。

Long-term follow up of bilateral subthalamic nucleus stimulation for Parkinson' s disease cases

Objective To present a large group of patients diagnosed with Parkinson＇ s disease （PD） who were treated with bilateral subthalamic nucleus （STN） deep brain stimulation （DBS）. Methods 195 consecutive patients who received implants at our institution for bilateral stimulation of the subthalamic nucleus. Macrostimulation and microrecording for STN identification were used in all cases. Patients were assessed at 1, 3, and 5 years with levodopa （on medication） and without levodopa （ off medication）, with use of the Unified Parkinson＇ s Disease Rating Scale. Results As compared with base line, the patients＇ scores at five years for motor function while off medication improved by 60.3% and those for activities of daily living improved by 54.2%. Speech was the only motor function for which off medication scores did not improve. The scores for motor function on medication did not improve one year after surgery, except for the dyskinesia scores. On-medication akinesia, speech, postural stability, and freezing of gait worsened between 1 year and 5 years . At five years, the dose of dopaminergic treatment and the duration and severity of levodopa-induced dyskinesia were reduced as compared with base line. Conclusions Patients with advanced PD who were treated with bilateral stimulation of the subthalamic nucleus had marked improvements over long-term follow up in motor function while off medication and in dyskinesia while on medication. There was no control group, but worsening of akinesia, speech, postural stability, freezing of gait, and cognitive function between the first and the fifth year is consistent with the natural history of PD.