丘脑底核脑深部电刺激术在改善帕金森病核心症状中的应用

目的探讨丘脑底核脑深部电刺激术在改善帕金森病(PD)核心症状中的疗效。方法选取行双侧丘脑底核脑深部电刺激术PD患者20例,采用自身前后对照法在基线和随访结束时(术后12个月)对患者运动症状、认知功能进行评估,观察患者术后不良反应,比较术前、术后日左旋多巴等效计量。结果术前及术后12个月时,服药状态下帕金森病评定量表第3部分(UPDRSⅢ)评分及各亚相评分均明显低于未服药状态(P0.05);术后12个月时,未服药及服药状态下的UPDRSⅢ评分及各亚相评分均明显低于术前(P0.05),服药后各个评分项目的改善率均明显高于术前(P0.05),VFT评分明显低于术前(P0.05),CDT评分明显高于术前(P0.05);术后1年日左旋多巴等效计量均较术前明显减少(P0.01);术后未见颅内出血、电极位置不当、脑脊液漏等并发症。结论双侧丘脑底核脑深部电刺激术能显著改善PD患者运动及认知功能,有效减少药物用量,手术安全性高,治疗效果显著。

Application of subthalamic nucleus deep brain stimulation in improving core symptoms of patients with Parkinson's Disease

Objective To explore the clinical efficacy of subthalamic nucleus deep brain stimulation in improving core symptoms of patients with Parkinson's Disease (PD).Methods A total of 20 patients with PD who received bilateral subthalamic nucleus deep brain stimulation were selected,their motor symptoms and cognitive capacity on the baseline and after the end of follow up (after postoperative 12 months) were evaluated using self-correlative controlled method,postoperative adverse reactions was observed,and the equivalent dose of daily levodopa before and after operation was compared.Results Scores of Unified Parkinson's Disease Rating Scale part Ⅲ(UPDRS Ⅲ)and each sub-phase scale were evidently lower before and after 12 months of operation in patients with drug administration than those without drug administration (P ＜ 0.05).The above scores were markedly lower after postoperative 12 months than operation before in patients with and without drug administration (P ＜ 0.05),and the improvement rate of each program score after drug administration was prominently higher than operation before (P ＜ 0.05),whereas verbal fluency test (VFT) was notably lower (P ＜ 0.05),and clock drawing test (CDT) was obviously higher after drug administration than operation before (P ＜ 0.05).The equivalent dose of daily levodopa was reduced more significantly after postoperative 1 year than operation before (P ＜ 0.01).None had postoperative complications like intra-cranial hemorrhage,improper position of electrodes,and leakage of cerebrospinal fluid.Conclusion Bilateral subthalamic nucleus deep brain stimulation,with high surgical safety and favorable therapeutic efficacy,can significantly improve PD patients'motor and cognitive function and effectively reduce the dosage of drug.