微电极导向苍白球腹后部毁损术治疗帕金森病

目的观察微电极导向苍白球腹后部毁损术治疗帕金森病的临床疗效.方法应用微电极导向苍白球腹后部毁损术治疗24例帕金森病患者,分析其术后临床症状的改善情况;平均随访时间4.2个月.结果术中靶点调整率82.5%,手术有效率100%;不同症状的改善率(%)分别为:僵直91.0,运动迟缓86.7,震颤83.3,步态73.4,平衡68.5,"关"状态76.0.左旋多巴引起的并发症基本消除,无严重及永久并发症.结论微电极导向苍白球腹后部毁损术治疗帕金森病,具有比传统的丘脑毁损术更加全面的治疗效果,尤其对运动迟缓和左旋多巴诱导的并发症更具治疗优势,副作用较少.微电极导向确保靶点的精确定位是手术成功的关键,远期疗效有待进一步观察.     

立体定向手术治疗帕金森病的临床研究

目的:总结微电极导向立体定向技术行脑内核团毁损和脑深部电刺激(DBS)治疗帕金森病的临床经验.方法:1999～2004年期间采用微电极导向立体定向毁损手术治疗帕金森病510例和DBS治疗帕金森病62例,其中脑核团毁损术组中行单侧苍白球腹后部毁损术(PVP)385例,丘脑腹中间核(Vim)毁损术91例,行同期同侧PVP和Vim毁损术12例,进行同期双侧PVP 8例,分期双侧PVP 10例,分期双侧PVP Vim术4例.DBS组中,刺激靶点为丘脑底核(STN)61例和Vim 1例,其中单侧31例,双侧31例.结果:脑核团毁损组于术后进行UPDRS运动评分,在"关"状态下症状改善率为47.3%;在"开"状态下症状改善率为23.4%.开-关症状和异动症均消失.220例平均随访11.6个月,其中显效130例(59.9%),改善75例(34%),无效15例(6.8%).DBS组术后UPDRS运动评分,在"关"状态下改善率为45.2%,在"开"状态下改善率为25.7%,平均随访11.8个月,其中40例于1个月内调整参数后再无调整,12例术后需再次调整参数.结论:根据患者的症状合理选择不同的脑核团毁损靶点,可明显控制患者症状.DBS手术并发症少,术后可调节参数,已成为治疗帕金森病的重要手术方法.     

微电极引导立体定向功能核团毁损术治疗帕金森病的临床分析

目的：研究微电极在立体定向功能核团毁损治疗帕金森病（PD ）的应用,并探讨其临床价值。方法回顾性分析该院84例未使用微电极引导立体定向功能核团毁损术治疗的PD患者（对照组）和74例使用微电极引导下立体定向功能核团毁损术治疗的PD患者（观察组）的临床病例资料。同时分别获得观察组及对照组核团毁损术前、术后不同服药状态下PD综合评分量表（UPDRS）评分,进而比较观察组及对照组功能核团毁损手术前后UPDRS运动评分的差异。结果观察组在术后3、6个月及1年的随访中UPDRS 运动评分较术前显著改善（P＜0．05）,同时患者术后抗帕金森病药物用量较术前减少（P＜0．05）。其中对照组显效70例（83．3％）,有效14例（16．7％）,总有效率100％;观察组显效62例（83．7％）,有效12例（16．3％）,总有效率100％。两种治疗方法在改善患者核团毁损手术前后的UPDRS 运动评分差异无统计学意义（P＞0．05）。结论立体定向功能核团毁损治疗PD疗效满意,微电极记录是否可显著提高手术的准确性有待进一步商榷。     

中西医结合治疗帕金森病术后并发症附:126例报告

目的：观察补阳还五汤对立体定向微电极导向射频毁损术治疗帕金森病后出现的并发症的疗效。方法：采用ＣＴ定位,立体定向微电极细胞电生理记录技术进行术中靶点监测,将２４０例帕金森病人的苍白球和（或）丘脑腹外侧核进行射频毁损术治疗后出现半身不遂、走路不稳、口眼Ｗａｉ斜患者,随机分为两组,分别给予单纯西医或中西医结合治疗。结果：中西医结合组显效率与单纯西医组比较,差异有统计学意义（Ｐ〈０．０５）。结论：补阳还五汤对立体定向微电极导向射频毁损术治疗帕金森病后出现的并发症有治疗效果。     

立体定向微电极导向射频毁损术治疗帕金森病240例

目的 介绍立体定向微电极导向射频毁损术治疗帕金森病及术后可能出现的并发症。方法 采用CT定位，立体定向微电极细胞电生理记录技术进行术中靶点监测，对240例帕金森病人的苍白球和(或)丘脑腹外侧核进行射频毁损术治疗。结果 手术效果优良，原有症状术后改善率97．6％。结论 立体定向微电极导向射频毁损术是目前治疗帕金森病的一种安全有效方法。     

脑深部核团电刺激与毁损术治疗帕金森病疗效比较

目的分别应用脑深部核团电刺激（deep brain stimulation,DBS）和核团射频毁损术治疗原发性帕金森病（Par-kinson＇s disease,PD）,对照研究DBS和射频毁损术对PD患者的肢体僵直、震颤、运动迟缓等症状的疗效。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。25例帕金森病患者进行丘脑底核电极植入,其中18例为一侧,7例为双侧同期植入;25例患者进行射频毁损术,其中21例行一侧毁损,4例行分期双侧射频毁损。两组患者术前UPDRS评分差异无统计学意义（P〉0.05）。术后所有患者经过6个月～5年的随访并行UPDRS评分。结果丘脑底核（STN）慢性电刺激及丘脑腹中间核（Vim）或/和苍白球腹后内侧部（Gpi）射频毁损术患者术后的肢体僵直、震颤、运动迟缓等症状均有不同程度的改善。在术后1个月、6个月、1年比较两组患者的UPDRS评分差异无统计学意义（P〉0.05）,而术后2年、3年、5年比较两组的UPDRS评分差异有统计学意义（P〈0.05）。结论目前DBS手术和射频毁损术是治疗PD有效的方法,二者在近期疗效方面差异无统计学意义,但在远期疗效方面DBS较射频毁损术有明显的优势。     

微电极导向立体定向手术治疗帕金森病120例报道

目的 :微电极导向、立体定向靶点毁损术技术在治疗帕金森病中的作用。方法 :采用微电极细胞电生理记录技术进行术中靶点监测 ,对 12 0例帕金森病患者行内侧苍白球腹后部 12例 ,丘脑腹外侧核 16例 ,苍白球腹后部和丘脑腹外侧核 92例毁损术 ,患者术前、术后评估采用Webster积分。结果 :手术效果优良率 98.4 % ,原有症状显著改善率平均达 98.4 % ,无永久并发症。结论 :应用微电极导向、立体定向手术治疗帕金森病手术并发症少 ,治疗效果好。     

微电极靶点定位外科治疗帕金森病

目的：探讨微电极记录技术在帕金森病外科治疗中的作用。方法：采用微电极电生理记录技术监测术中靶点,对帕金森病３１例进行手术治疗,其中苍白球毁损术１４例、丘脑毁损术６例、深部脑电刺激术１１例。结果：最终毁损靶点较ＭＲ定位靶点位置更换率为８０．６％,手术效果优良,有效率１００％,原发有太术后改善率达８７．１％,无永久并发症。结论：微电极记录技术的应用能显著提高定位精度,减少并发症和提高手术效果。     

脑深部电刺激治疗帕金森病病例报告及文献回顾

目的观察脑深部电刺激治疗原发性帕金森病的治疗效果。方法在微电极的引导下,将刺激电极植入单侧丘脑底核(STN),在未服药状态下,于术前、术后1个月、术后3个月和术后6个月为患者进行UPDRS运动评分(UPDRSⅢ),评价治疗效果。结果术前、术后1个月、术后3个月和术后6个月UPDRS运动评分(UPDRSⅢ)分别为57、30、26、24,随访6个月后缓解率为57.89%。结论单侧电刺激丘脑底核治疗帕金森病初步显示出良好的效果。     

立体定向微电极导向射频毁损术治疗帕金森病108例

目的 介绍立体一定向微电极导向射叔毁损术治疗帕金森病及术后可能出现的并发症。方法 采用ＣＴ定位立体定向微电极细胞电生理记录技术进行术中靶点监测,对１０８例帕金森病人的苍白球和（或）丘脑腹外侧核进行射频毁损术治疗。结果 手术效果优良,原有症状术后改善率９８．１％,无永久并发症。结论 立体定向微电极导向射频毁损术是目前治疗帕金森现的一种安全有效方法。     

Vim thalamic stimulation for tremor

Chronic stimulation of the ventral intermediate nucleus (Vim) of the thalamus is highly effective for the treatment of tremor. Patients with tremor associated with Parkinson's disease and essential tremor appear to respond best. Patients with cerebellar tremors may also respond but to a lesser extent. Although tremor is improved, Vim DBS does not substantially improve the daily living activities of patients with Parkinson's disease. This is related to the lack of effect on rigidity, bradykinesia, and gait and postural disturbances associated with Parkinson's. For this reason, the majority of patients with Parkinson's disease who require surgery are better treated with interventions in the globus pallidus or subthalamic nucleus, targets that allow improvement in all cardinal features of Parkinson's disease. In contrast, Vim DBS has unequivocal functional benefit in patients with essential tremor, this is likely to remain the major indication of this form of therapy. The mechanism of action of thalamic DBS is not understood and remains a research priority.     

帕金森病患者伴发抑郁症状及相关因素的临床研究

目的:探讨帕金森病(PD)患者伴发抑郁症状的临床特点及相关因素。方法:对65例PD患者与健康对照组入选者进行汉密尔顿抑郁量表(HAMD)评分,并用帕金森病评定量表(UPDRS)对PD患者进行病情程度评定。结果:PD伴发抑郁症状的发生率为46.2%,其中轻度抑郁占51.6%,中-重度抑郁占48.4%。僵直型PD、震颤-僵直型PD患者绝望感、阻滞及睡眠障碍因子分明显高于震颤型PD。PD病程越长,UPDRS评分和Hoehn-Y ahr分型越高,抑郁发生率越高。抑郁程度与年龄、性别、受教育程度无相关性,而与病程、病情程度相关。结论:PD患者伴发抑郁症状发生率高,不同临床类型,PD有其抑郁特点,僵直型PD患者更易出现抑郁症状,其抑郁程度与PD患者病程、病情程度密切相关。     

巴金森氏病智力损害与年龄、病程、运动障碍的关系

巴金森氏病病人的年龄、起病年龄、病程、运动障碍的严重程度与其智力损害的关系至今仍存有争议。为此用定量的临床评定方法、标准化的韦氏成人智力测验对31名连续收选的特发性巴金森氏病进行了研究。结果发现缓动的严重程度与智力损害明显相关,而震颤严重程度与智力损害呈反相关。病人的年龄、起病年龄、病程及强直的程度与智力损害无明显相关。这些结果提示引起缓动的皮层下脑损害同样可能引起智力损害,而有明显震颤的巴金森氏病可能属于该病的早期或属于智力损害较轻的一种巴金森氏病亚型。     

Microelectrode-guided Technique for Treatment of Parkinson‘s Diseases

The microelectrode- guided technique is a newtechnique introduced in 90 s of lastcentury,whichcan allow the operational accuracy much higherthan that the traditional operative localization did.We began to use the techniques from 2 0 0 0 andhave achieved good results in our work.Presentedin this report are the preliminary results.1　 CLINICAL DATA AND METHODS1 .1　 General DataThe patients included1 8men and9women.Their mean age was 6 2 years old,with a range of43— 75 .The mean durat…     

双侧丘脑底核脑深部电刺激治疗中晚期帕金森病的疗效

目的 研究双侧丘脑底核(STN)脑深部电刺激(DBS)对中晚期帕金森病(PD)患者的疗效.方法 对2006年8月至2010年1月在中山大学附属第一医院接受双侧STN DBS治疗的中晚期PD患者于术前、术后分别应用统一帕金森病评分量表(UPDRS)、Hoehn&Yahr(H&Y)分级、帕金森病生活质量问卷(PDQ-39)、简易智能状态检查(MMSE)、帕金森病睡眠评估量表中文版(PDSS-CV)、匹兹堡睡眠质量指数(PSQI)及汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)等评价其临床情况;同时记录各时间点抗PD药物的剂量及DBS相关参数.结果 10例患者术后随访满1年,开机未服药及开机服药状态与术前未服药状态相比UPDRS-Ⅲ运动评分、震颤、强直、迟缓及中轴症状得分均显著降低,其中以震颤改善率最高(52.1%与77.7%),与术前服药状态相比差异无统计学意义.觉醒状态"关"期时间由术前6.3 h/d缩短至1.8 h/d(P=0.008),术后H&Y分级及PDQ-39降低,差异均有统计学意义.非运动症状评分无明显变化.术后1年抗PD药物较术前显著减少49.2%.结论 双侧STN DBS术对中晚期PD患者的运动症状疗效肯定,能有效减少抗帕金森病药物用量,提高患者生活质量.手术具有安全性高、并发症较少且可调控的优点.

Abstract：

Objective To study the effects of deep brain stimulation (DBS) of bilateral subthalamic nucleus (STN) on the motor and non-motor symptoms in moderate or advanced Parkinson's disease (PD) patients. Methods From August 2006 to January 2010, 21 consecutive PD patients with refractory motor fluctuations or dyskinesia underwent operations at our hospital. All patients were evaluated by unified Parkinson's disease rating scale (UPDRS), Hoehn & Yahr (H&Y) stage, Parkinson's disease questionnaire (PDQ-39), mini mental state examination (MMSE), Parkinson's disease sleep scale-Chinese vision( PDSS-CV), Pittsburgh sleep quality index ( PSQI), Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA). And the daily dosage of dopaminergic agents was recorded at 1week pre-operation and 3, 6 and 12 months post-operation. Results Ten patients finished a 12-month follow-up. Their motor functions showed significant improvement. And the scores of UPDRS-motor, tremor,rigidity, bradykinesia and axial symptoms reduced significantly in the on-stimulation-off-medication condition and the on-stimulation-on-medication condition vs the on-medication condition pre-operation. And the improvement of tremor was the most pronounced ( 52. 1% and 77.7% respectively ) . The H&Y stage decreased significantly from 3.2 ± 0. 7 to 2. 5 ± 0. 4 post-operation. The activities of daily living improved while PDQ-39 declined significantly from 56 ±9 pre-operation to 32 ± 13 at 12 months follow-up. The score changes of MMSE, PDSS-CV, PSQI, HAMA and HAMD were statistically insignificant. The levo-dopa equivalent dose of 1-year post-operation decreased significantly by 49.2% versus that of pre-operation ( P ＜0.05). Conclusion Bilateral STN-DBS can significant ameliorate the motor symptoms of moderate or advanced PD patients, reduce the dosage of anti-PD medications and improve the quality of life. This procedure has the advantages of a greater safety, minor side effects and an easy controllability.     

5: Movement disorders I: parkinsonism and the akinetic-rigid syndromes

The major features of akinetic-rigid syndromes are bradykinesia (small, slow movements), rigidity and tremor, often summarised as "parkinsonism". Approximately 80% of akinetic-rigid syndromes are due to Parkinson's disease. Treatment of Parkinson's disease should be determined by level of disability and handicap. The combination of levodopa and peripheral dopadecarboxylase inhibitor is the most efficacious symptomatic treatment for Parkinson's disease. Motor fluctuations appear after 2-3 years of levodopa treatment, and affect at least 50% of patients after five years. Surgery can relieve refractory tremor and dyskinesias, but does not alter disease progression or need for drug therapy.     

Quantitative assessment of Parkinson''s disease deficits

OBJECTIVE To quantitatively analyze the tremor and rigidity due to Parkinson's disease.

METHODS 38 patients with Parkinson's disease (PD) ranging in age from 45 to 72 years and 211 normal subjects aged from 16 to 76 years were investigated. The frequency and range of tremor, the muscle tone of the upper limbs in elbow were detected by a computerized video motion detecting system and a new invented apparatus which can detects skeletal muscle tone.

RESULTS For the PD patients, the frequency of resting tremors was detected in 4 to 6 per second. For extensor and flexor in the PD patients, the value of muscle tone was higher than that of normal subjects and the value of muscle tone in flexor was higher than that of extensor. The rigidity increased gradually with repeat passive movement. The curves of rigidity were shown on computer screen or printed out. The data of rigidity were compared with the M-A Scale. A patient who was suspected to suffer from PD above by the equipments and found the muscle tone was higher than normal. In another PD patient the rigidity was obvious at one side and the muscle tone in "normal side" was also high. These equipments were used to record changes of rigidity and tremor in one more PD patient taking with different drugs in order to see the drug effect.

CONCLUSIONS Quantitative methods are useful to analyse the motion disorders due to PD.

     

微电极导向立体定向手术治疗帕金森病

目的：总结微电极导向立体定向手术治疗帕金森病的临床经验及治疗效果。方法：自1999年4月至2001年2月采用微电极导向立体定向手术治疗帕金森病350例。其中行苍白球腹后部毁损术（PVP）278例,丘脑腹中间核（Vim)毁损术35例,行同期同侧PVP和Vim毁损术15例,行同期双侧PVP11例,分期双侧PVP8例,分期一侧PVP、另一侧Vim毁损术3例。对手术前后的“关”状态和“开”状态进行日常生活量表评分、统一帕金森病评定量表（UPDRS）评分,并进行门诊随访或家访。结果：术后日常生活能力评分“关”状态提高29．8％,“开”状态提高25．9％。UPDRS评分在“关”、“开”状态下,总的症状改善率分别为57．3％和33．4％,其中精神行为情绪改善率为50．8％和28．9％,日常活动改善率为59．1％和35．9％,运动功能改善率为58．2％和34．7％。结:PVP地大多数症状均有效,但对震颤的效果不如Vim毁损术;对震颤明显、无明显僵直的患可选择Vim毁损术;对震颤僵直型患可行同期双侧PVP或同期PVP加Vim毁损术。     

选择性丘脑腹中间核毁损术治疗震颤型帕金森病

目的：探讨选择性丘脑腹中间核（Vim)毁损术的手术方法及对震颤型帕金森病的疗效，方法：CT解剖定位，微刺激，微记录及放大刺激进行神经电生理校对，行小灶性毁损，手术前后行UPDRS分项计分，手指拍击实验和行走试验并计算改善率，结果，33例震帕金森病患者术中完体控制震颤，UPDRS分项计分，手指拍击实验和行走试验及改善率均显示术手疗效显著，2wk后复发1例，轻度构音障碍1例，结论：选择性丘脑Vim毁损术对震颤型帕金森病有显著疗效，严格掌握手术造应证，合理应用 微电极技术，适当的毁损体积是手术成功的关键。     

Deep brain stimulation of the subthalamic nucleus in Parkinson's disease

OBJECTIVE: To evaluate the effects of bilateral deep brain stimulation in the subthalamic nucleus for symptomatic relief of advanced idiopathic Parkinson's disease. DESIGN: Prospective cohort study. SETTING: Patients were assessed and received medical treatment at the Kingston Centre, Southern Health, Melbourne. Surgery took place at Melbourne Neuroscience Centre, The Royal Melbourne Hospital. Both are tertiary public institutions. SUBJECTS: 14 patients with Parkinson's disease with intact cognition and difficult to manage motor symptoms who were referred to Kingston Centre between 1996 and 2000 and were eligible for surgical intervention. INTERVENTIONS: All patients were assessed both after 12 hours' withdrawal from and while taking their levodopa medication on two occasions before surgery. Further assessments were carried out one, three, six and 12 months after surgery. MAIN OUTCOME MEASURES: The Unified Parkinson's Disease Rating Scale motor exam and gait parameters, such as stride length and velocity, were compared at six months after surgery with neither stimulation nor medication, with stimulation only, with medication only, and with stimulation and medication. RESULTS: Stimulators were explanted in one patient after intracranial haemorrhage and relocated to the thalamus in a second. Extraneous factors prevented two patients from attending at six-month follow-up. Motor performance improved significantly with stimulation alone in the 10 remaining patients. Further significant gains were seen with stimulation and medication combined, with an apparent reduction in side-effects such as dyskinesia. CONCLUSIONS: Bilateral deep brain stimulation of the subthalamic nucleus significantly improves motor performance in advanced Parkinson's disease, despite a rather high complication rate.