脑深部电刺激治疗运动障碍病276例病例分析

目的 分析276例运动障碍病(MD)的脑深部电刺激(DBS)治疗效果和经验.方法 276例MD患者接受421侧DBS植入手术治疗.其中含帕金森病(PD)232例,原发性震颤(ET)7例,肌张力障碍(DT)25例,抽动秽语综合征(TS)5例,Meige综合征等其他病例7例.结果 PD患者UPDRS运动功能评分(关状态)平均改善率45.6%.手术后非运动症状(NMS)出现频数明显下降的是:疼痛、感觉异常、失眠、多梦、不安腿、体质量下降.ET患者双上肢震颤完全停止(单侧DBS手术者除外).DT患者BFM改善率22.0%～95.8%,个体间差异较大.TS患者YGTSS综合评分改善率43.2%.强迫症状明显减轻.结论 DBS是有肯定疗效的MD治疗手段,但许多问题值得探讨.DBS可以使PD患者一部分NMS症状和TS患者强迫症状得到改善,对于情感障碍的治疗有借鉴意义.DBS对于原发性DT有较好的疗效,但对于继发性和不同分布特点的DT,缺乏预实验确定手术适应证,也没有对照研究确定最佳DBS靶点.

Deep brain stimulation for movement disorders in a series of 276 patients

Objective To discuss the therapeutic effect of deep brain stimulation for movement disorders in a series of 276 patients. Method A consecutive series of 276 patients with movement disorders underwent DBS performed by the same operative team were involved in this study. These patients suffered mainly from Parkinson's disease (PD), essential tremor (ET), dystonia (DT) and tourette syndrome (TS).Results Significant improvement of motor abilities(UPDRS) was observed in PD patients by 45.6%. There was a significant association of non-motor symptoms(NMS) score in PD patients with Hoehn-Yahr stage (r =0.49, P =0. 00). Six items of NMS(pain, paraesthesia, insomnia, vivid dreaming, restless legs, weight loss) were significantly less reported by PD patients postoperatively (Pearson Chi-square test, P =0. 00～0. 02). Stimulation of the ventral-internal nucleus of the thalamus was an effective treatment for ET with sustained long-term effects. The individual improvement rate of DT varied from 22. 0% to 95. 8% followed by delayed but steady progress. Patients with TS showed substantial reduction of tics and compulsions. Conclusions DBS has become an increasingly common surgical treatment of movement disorders. However, many aspects of this promising intervention remain uncertain. According to STN-DBS for PD and Gpi-DBS for TS, detailed neuropsychological evaluations may be helpful to further understand the mechanisms underlying some aspects of the clinical features. Good results have been achieved in patients with primary dystonia due to undergoing GPi or STN DBS. However, without controlled studies evaluating, the optimal stimulation target for different subtypes of dystonia is still unknown. And there is no predictive clinical test comparable to levodopa response in PD.