脑深部电刺激对帕金森病非运动症状的疗效(附102例病例分析)

目的 探讨丘脑底核(STN)脑深部电刺激(DBS)对帕金森病(PD)非运动症状的治疗作用.方法 102例PD病人接受STN-DBS手术,手术前后分别进行非运动症状(NMS)量表评估,随访时间6个月至6年.结果 PD患者术前有NMS症状3～18项,平均7.1项.NMS评分与患者的Hoehn-Yahr分级明显相关(相关系数r=0.49,P<0.01).手术后频数明显下降的NMS症状是:疼痛、感觉异常、失眠、多梦、不安腿、体质量下降.结论 所有PD患者都具有NMS症状,出现在PD病程的各个时期.随疾病严重程度的进展,PD患者平均NMS评分明显提高.DBS手术不能改善PD患者的所有NMS症状,但可以减少疼痛、感觉异常、失眠、多梦、不安腿、体质量下降等症状.

Non-motor effects of subthalamic nucleus deep brain stimulation in parkinson's disease: experience in a series of 102 patients

Objective This study evaluated the effects of relieving the non-motor symptoms (neuropsychiatry,sleep disorders,antonomic,gastrointestinal and sensory disorders) of STN DBS in patients with PD followed up for a half to six years. Method A consecutive series of 102 patients was assessed one week before and a haft to six years after surgery. The non-motor symptoms(NMS) questionnaire was used to assess the range of NMS and outcome after surgery. The NMS questionnaire comprised 23 items which were designed simply to be understood for patients. Besides, depression was evaluated using self-completed depression scale (SDS). Anxiety was evaluated using self-completed anxiety scale (SAS) system. All these scales were performed at every evaluation. Results Before surgery, on average, patients reported 7.1 NMS in average. There was a significant association of NMS score in PD patients with Hoehn-Yahr stage ( r =0.49, P<0.01). After surgery, NMS was still common in PD patients. However,six items of NMS (pain, paraesthesia, insomnia, vivid dreaming, restless legs, weight loss) were significantly less reported postoperationly by PD patients than pre-operation state(Pearson Chi-square test, P=0.00～0.02). While other problems of NMS,especially the score of depression and anxiety did not change. Conclusions NMS can be observed in all PD patients across all disease stages and correlates to the disease progression. STN DBS do not lead to comprehensive improvement of NMS in PD. However, STN DBS may contribute to the reducing of several items of NMS:pain ,paraesthesia, insomnia, vivid dreaming,restless legs and weight loss.