立体定向微电极导向射频毁损术治疗帕金森病375例

目的 探讨立体定向微电极导向射频毁损术治疗帕金森病(PD)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375例PD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91％。结论 立体定向微电极导向射频毁损术是目前治疗PD的一种安全有效方法。     

微电极引导立体定向手术改善老龄帕金森病患者静止性震颤、僵直及运动迟缓的效果分析

目的介绍微电极引导立体定向手术治疗老龄帕金森病(PD)改善静止性震颤、僵直、运动迟缓的方法和结果。方法采用立体定向手术,术中行微电极记录技术靶点监测,对28例70岁以上老龄PD患者行丘脑腹外侧核(VL)、苍白球腹后内侧部(Gpi)射频毁损,其中2例A型(震颤型)患者行单侧VL毁损术,1例A型患者行双侧VL毁损术;26例行Gpi毁损术,其中1例行同期单侧Gpi及VL毁损术,术前及术后12月应用motorUPDRS量表进行评价。结果2例VL毁损术后12月,肢体静止性震颤完全或基本消除,其中1例下颌静止震颤有明显缓解;26例行Gpi毁损术,术后静止性震颤、僵直、运动迟缓均有较大改善。结论微电极引导立体定向手术是治疗老龄PD的有效手段之一,但是要严格掌握适应证。     

微电极导向立体定向毁损术改善帕金森病症状的中远期疗效分析

目的评价微电极导向立体定向毁损术治疗帕金森病 ( PD) 的中远期疗效及总结临床治疗经验 . 方法对行微电极导向选择性苍白球腹后部和 /或丘脑损毁术的 102例次 PD患者的临床及随访资料进行分析 . 结果全组随访 3个月～ 2年 . 其中 72例随访 1年以上 , 平均 1.6年 . 6例患者的运动迟缓症状于手术半年后有不同程度的复发 , 震颤、僵直、药物诱发的运动障碍等症状及大部分患者的日常生活活动基本维持稳定的改善 . 无严重、永久的并发症 . 结论微电极导向立体定向毁损术治疗 PD有普遍稳定的疗效 , 其中以震颤、僵直及药物所致的运动障碍的改善稳定性较好、运动迟缓及中轴症状次之 . 除毁损靶点的精确定位外 , 适应证的合理选择以及科学合理的术后用药和康复治疗是全面提高疗效、改善患者中远期生存质量的重要因素 .     

微电极引导立体定向手术改善老龄帕金森病患者静止性震颤、僵直及运动迟缓的效果分析

目的：介绍微电极引导立体定向手术治疗老龄帕金森病（PD）改善静止性震颤，僵直，运动迟缓的方法和结果。方法：采用立体定向手术，术中行微电极记录技术靶点监测，对28例70岁以上老龄PD患行丘脑腹外侧核（VL），苍白球腹后内侧部（Gpi)射频毁损，其中2例A型（震颤型）患行单侧VL毁损术，1例A型患行双侧VL毁损术；26例行Gpi毁损术，其中1例行同期单侧Gpi及VL毁损术，术前及术后12月应用motor UPDRS量表进行评价。结果：2例VL毁损术后12月，肢体静止性震颤安全或基本消除，其中1例下颌静止震颤有明显缓解；26例行Gpi毁损术，术后静止性震颤，僵直，运动迟缓均有较大改善。结论：微电极引导立体定向手术是治疗老龄PD的有效手段之一，但是要严格掌握适应证。     

立体定向多靶点联合毁损术治疗难治性精神病179例分析

目的：探讨立体定向多靶点联合毁损术治疗难治性精神病的手术效果。方法：采用螺旋CT定位,微电极导向同期多靶点联合行射频热凝毁损术治疗难治性精神病179例。结果：术后1-6个月经过CGI评定,显著进步128例,进步36例,无效15例,有效率91.6%。结论：立体定向多靶点联合毁损术是治疗难治性精神病的有效方法,选择最佳靶点组合,手术方案个体化,有助于提高疗效,降低并发症。     

微电极引导结合术中电生理刺激定位射频对帕金森病患者肢体震颤与僵直及运动迟缓的改善作用

目的:探讨立体定向微电极引导结合术中电生理刺激精确定位射频治疗帕金森病的方法和疗效。方法:98例帕金森病患者为1998-05/2003-12河北医科大学第一医院神经外科收治,对患者先进行螺旋CT扫描影像学定位后,术中在微电极监测引导下进行细胞生理定位并结合电生理刺激验证进行丘脑腹中间核和/或苍白球腹后内侧部射频毁损术。观察术前术后对药物反应情况和症状改善程度。结果:电生理监测下的立体定向射频毁损术对帕金森病患者的震颤、僵直、运动迟缓均有明显的改善,其中对震颤的缓解率为100%,运动迟缓改善率69%,僵直症状术后75%明显改善。Hoehn-Yahr分级显著改善,并发症的发生率较单独应用电刺激明显减少。结论:术中应用微电极技术结合电生理刺激的立体定向射频毁损术对帕金森病有良好的治疗效果。     

立体定向苍白球毁损治疗帕金森病

目的:评价立体定向苍白球腹后部毁损术治疗帕金森病的疗效。方法:对42例原发性帕金森病患者应用MRI行苍白球腹后部定位。以微电极进行功能定位后,应用射频毁损治疗。手术前后进行UPDRS计分并计算改善率。结果:42例均有显著疗效,术后5例出现轻微并发症。症状改善率,开状态(71.1±8.2)%、关状态(86.1±9.2)%(P<0.001)。平均随访34个月,疗效稳定。结论:立体定向苍白球腹后部毁损术治疗帕金森病疗效显著。     

丘脑腹外侧核、苍白球腹后外侧部毁损术治疗帕金森氏病疗效

目的 :研究计算机辅助立体定向脑内靶点定位与术中电生理刺激结合确定丘脑腹外侧核 (VL)、苍白球腹后外侧部 (VPLP)在治疗帕金森氏病 (PD)中的作用。方法 :对 5 8例PD患者先进行立体定向CT扫描 ,将扫描资料在专用的计算机中确定解剖学靶点后 ,再于术中进行电生理刺激的方法验证和纠偏 ,根据调整后的结果进行射频毁损。结果 :立体定向CT扫描计算机定位准确率达 93% ,电生理纠偏率为 7%。结论 :立体定向CT扫描计算机定位准确性很高 ,但术中电生理刺激验证和纠偏仍有必要。     

微电极导向内侧苍白球腹后部毁损术改善帕金森病合并轻中度抑郁的机制

目的分析评估微电极导向内侧苍白球腹后部毁损术对帕金森病(PD)合并轻中度抑郁的疗效,探讨其机制。方法PD合并轻、中度抑郁患者36例,于微电极导向单侧苍白球腹后部毁损术前10d及术后2周进行肢体运动功能障碍及抑郁疗效的评估。结果36例患者术后在肢体运动功能障碍明显改善的同时,其抑郁情绪亦有明显的改善,Webster记分、SDS总分、HAMD总分均较术前明显降低(P<0.01),有效率91.67%。靶点更换率100%,经微电极导向技术再确认的靶点较影像学确定的靶点更偏向内侧苍白球的内侧及腹侧。结论微电极导向的内侧苍白球腹后部毁损术对PD合并的轻、中度抑郁有明显的改善作用。     

微电极引导结合术中电生理刺激定位射频对帕金森病患者肢体震颤与僵直及运动迟缓的改善作用

探讨立体定向微电极引导结合术中电生理刺激精确定位射频治疗帕金森病的方法和疗效。方法：98例帕金森病患为1998—05／2003-12河北医科大学第一医院神经外科收治，对患先进行螺旋CT扫描影像学定位后，术中在微电极监测引导下进行细胞生理定位并结合电生理刺激验证进行丘脑腹中间核和／或苍白球腹后内侧部射频毁损术。观察术前术后对药物反应情况和症状改善程度。结果：电生理监测下的立体定向射频毁损术对帕金森病患的震颤、僵直、运动迟缓均有明显的改善，其中对震颤的缓解率为100％，运动迟缓改善率69％，僵直症状术后75％明显改善。Hoehn-Yahr分级显改善，并发症的发生率较单独应用电刺激明显减少。结论：术中应用微电极技术结合电生理刺激的立体定向射频毁损术对帕金森病有良好的治疗效果。     

分期立体定向双侧多靶点毁损术治疗帕金森病第二次手术单项症状改善率及其并发症分析

背景帕金森病患者第1次手术后肢体症状有所缓解,随病程进展或病情复发,肢体症状会加重,药物不能控制时需要行第2次手术来缓解症状.目的探讨第2次手术治疗帕金森病患者单项症状改善率及其并发症的差异.设计病例分析.单位解放军第一五三中心医院神经外科和解放军第四军医大学唐都医院神经外科.对象选择1997-10/2002-12到解放军第一五三中心医院神经外科和第四军医大学唐都医院神经外科就诊的原发性帕金森病患者387例,两次均在同一医院治疗350例,第1次在外院手术,第2次来本院治疗37例.两次手术间隔时间半年以内36例,0.5～0.9年72例,1.0～1.9年108例,2.0～5.0年171例.方法所有患者均在立体定向微电极引导下,采用靶点的影像学定位、微电极记录、微电极刺激探测靶点、射频电极刺激验证靶点,行分期双侧苍白球腹后内侧部或丘脑腹中间核毁损术,术前及术后1周在药物"开"状态下(药物开始起作用时,患者活动自如,处于"开"状态);"关"状态下(当药物失去作用时,患者的活动变得困难,处于"关"状态)进行统一帕金森病评定量表评分.主要观察指标①帕金森病患者第2次手术单项症状改善率.②帕金森病患者第2次手术后并发症与第1次比较.结果387例患者全部进入结果分析.①两次单项症状改善率第2次手术单项症状改善率低于第1次(震颤95.4%,96.9%;僵直94.6%,95.1%;运动迟缓88.9%,92.3%;步态62.3%,67.1%;平衡65.1%,69.4%;异动症和痛性痉挛95.8%,98.0%),但经统计学处理,差异无显著性意义(P＞0.05).②两次手术后统一帕金森病评定量表评分均低于术前(P＜0.01).第2次手术开状态下统一帕金森病评定量表评分平均改善率为46.8%,关状态下平均改善率为53.5%,低于第一次手术(51.5%,61.6%).③帕金森病患者两次手术后并发症比较第2次手术的特异性并发症,包括乏力感,流涎,音量降低,假性球麻痹,嗜睡,呃逆,尿失禁,尿潴留等明显高于第1次手术(P＜0.05).脑出血发生率低于第1次手术.结论①第2次手术的单项症状改善率和统一帕金森病评定量表评分较低,可能是第2次手术时患者病情较第1次重,多处于帕金森病晚期的原因.②第2次手术的特异性并发症明显增高,可能与患者的年龄、病情、体质、手术方式、时间间隔有关.两次手术非特异性并发症发生率基本相同(脑出血、感染),说明第2次手术的出血风险并未增加.     

帕金森病抑郁的临床特征、影响因素及治疗

目的探讨帕金森病(PD)合并抑郁患者的临床特征、影响因素及治疗,为临床治疗PD提供进一步依据。方法统计81例PD患者帕金森病抑郁(PDD)发病率,比较PDD组与PD非抑郁(PDND)组年龄、病程、统一PD评定量表(UPDRS)评分、性别、Hoehn-Yahr分期、临床分型的差异及汉密尔顿抑郁量表(HAMD)因子分差异。比较采用抗PD药物合并抗抑郁药与单纯使用抗PD药物治疗PDD 30天后UPDRS及HAMD评分的变化。结果81例PD患者中52例并发抑郁,其中轻度抑郁31例(59.6%),中重度抑郁21例(40.4%)。震颤为主型抑郁发生率44.4%,强直为主型抑郁发生率为69.8%。UPDRS分值越高、Hoehn-Yahr分期越高、女性、强直为主型更容易合并抑郁。PDD主要表现在焦虑/躯体化、认识障碍、阻滞、睡眠障碍及绝望感方面。抗PD药物合并抗抑郁药治疗能显著降低患者的UPDRS及HAMD评分。结论PD合并抑郁比较常见,以轻度抑郁为主,UPDRS分值越高、Hoehn-Yahr分期越高、女性、强直为主型更容易合并抑郁。治疗上使用抗PD药物联用抗抑郁药优于单纯抗PD药物。     

微电极引导立体定向手术治疗帕金森病的研究

Objective To study the methods and outcome of 71 patients with Parkinson's disease treated with microelectrode-guided stereotactic pallidotomy and thalamotomy. Method Pallidal and thalamal target sites are chosen by supervision of microelectrode recording technique in 71 patients with Parkinson's disease. The UPDRS motor score was used to evaluate the outcomes 12 weeks before and after operation Result After 12 months follow-up, tremor disappeared completely or nearly completely in 12 patients who underwent unilateral and l bilateral ventrolateral thalamotomy. Dramatic improvement of tremor, rigidity, bradykinesia were observed in 57 patients underwent posteroventral pallidotomy,including 6 underwent bilateral posteroventral pallidotomy. Intracerebral hemorrhage was observed in l patient. Conclusion Microelectrode-guided stereotactic pallidotomy and thalamotomy are effective in treatmenting Parkinson's disease, but with serious complications     

Efficacy of rasagiline for the treatment of Parkinson’s disease: an updated meta-analysis

Objective: Rasagiline is a second-generation potent selective inhibitor of monoamine oxidase-B. The aim of the study was to analyze the effectiveness of rasagiline in treatment of Parkinson’s disease (PD), both as monotherapy and combination therapy.

Methods: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until 9 March 2016 using the keywords: Rasagiline, Azilect, Parkinson’s disease. Randomized controlled trials of patients with PD who were randomized to treatment with rasagiline or placebo were included. Outcomes were unified Parkinson’s disease rating scale (UPDRS) and the three subscales.

Results: Ten studies fulfilled the inclusion criteria and 2709 patients were evaluated. The overall analysis revealed a significant improvement in change of total UPDRS scores in 1?mg/day and 2?mg/day rasagiline groups compared to placebo. Significant improvement in Part I (Mentation) of UPDRS scores was observed in 1?mg/day, but not in 2?mg/day rasagiline treatment group. Part II (ADL) and Part III (Motor) subscales significantly improved with both doses of rasagiline. Both monotherapy and combination therapy significantly improved total UPDRS scores.

Conclusions: Our results confirm the efficacy of rasagiline in PD. Further studies are required to establish the optimal dose of rasagiline, as well as to determine its effectiveness in different combination therapy protocols.

• KEY MESSAGES

• Rasagiline treatment was associated with significant improvement of UPDRS scores and the scores of the subscales.

• Both monotherapy and combination therapy significantly improved total UPDRS scores.

• Effect of rasagiline on total UPDRS scores was not dose-dependent.

     

Pramipexole safely replaces ergot dopamine agonists with either rapid or slow switching

This prospective, open-label, multicentre study examined the efficacy and safety of rapidly (overnight) or slowly (after 2 weeks of concomitant usage) switching patients with Parkinson's disease (PD) from conventional ergot dopamine agonists (DAs) to the non-ergot DA, pramipexole. Fifty-nine early-to-advanced PD patients with motor symptoms that were inadequately controlled by ergot DAs were enrolled. Patients were switched from ergot derivatives to pramipexole and evaluated every 2 weeks for 12 weeks by Hoehn and Yahr staging, Unified Parkinson's Disease Rating Scale (UPDRS) and a modified Epworth Sleepiness Scale (mESS). The UPDRS III subscores and total UPDRS scores significantly improved, independent of switching method. Adverse events, all of which were mild, occurred in 29.2% of patients. No sudden onset of excessive daytime sleepiness or significant worsening in mESS was seen. Switching patients with PD from ergot DA to pramipexole, using either a slow or rapid switching method, appeared to be well tolerated and effective, although further dose adjustment may be necessary in some patients after the switch.     

Testing functional performance in people with Parkinson disease

BACKGROUND AND PURPOSE: Although the Unified Parkinson's Disease Rating Scale (UPDRS) is the most common performance measure for people with Parkinson disease (PD), the Berg Balance Scale (BBS), Forward Functional Reach Test (FFR), Backward Functional Reach Test (BFR), Timed "Up & Go" Test (TUG), and gait speed may be used to quantify some aspects of functional performance not measured by the UPDRS. The purpose of this study was to describe the relationship among a set of tests of balance, walking performance, and mobility in people with PD. SUBJECTS: Twenty-five community-dwelling adults (11 female, 14 male) with a diagnosis of PD were recruited from PD support groups in southeastern Wisconsin and consented to participate in the study. The mean age of the participants was 76 years (SD=7). The average Hoehn and Yahr Stage Scale score was 2. METHODS: Functional abilities of each subject were assessed with the UPDRS, BBS, FFR, BFR, TUG, and gait speed. Spearman and Pearson correlations were performed. RESULTS: The UPDRS total score was correlated with the BBS (r=-.64, P<.001), FFR (r=-.52, P<.05), and TUG (r=.50, P<.05) measurements. The BBS is the only test of functional performance where scores correlate with all other functional tests and the UPDRS. DISCUSSION AND CONCLUSIONS: The UPDRS total score may not reflect a comprehensive measure of mobility in people with PD. Because the BBS scores correlate both with UPDRS scores and with scores of all other tests of functional performance, the BBS appears to be a good overall measure of function in this population.     

Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson's disease: a pilot study

OBJECTIVE: To evaluate the effects of 6 weeks of intensive treadmill training on gait rhythmicity, functional mobility, and quality of life (QOL) in patients with Parkinson's disease (PD). DESIGN: An open-label, before-after pilot study. SETTING: Outpatient movement disorders clinic. PARTICIPANTS: Nine patients with PD who were able to ambulate independently and were not demented. Mean age was 70+/-6.8 years. Patients had mild to moderate PD (Hoehn and Yahr stage range, 1.5-3). INTERVENTIONS: Patients walked on a treadmill for 30 minutes during each training session, 4 training sessions a week, for 6 weeks. Once a week, usual overground walking speed was re-evaluated and the treadmill speed was adjusted accordingly. MAIN OUTCOME MEASURES: The 39-item Parkinson's Disease Questionnaire (PDQ-39), motor part of the Unified Parkinson's Disease Rating Scale (UPDRS), gait speed, stride time variability, swing time variability, and the Short Physical Performance Battery (SPPB). RESULTS: A comparison of the measures taken before and after the treadmill intervention indicates general improvement. QOL, as measured by the PDQ-39, was reduced (improved) from 32 to 22 (P<.014). Parkinsonian symptoms, as measured by the UPDRS, decreased (improved) from 29 to 22 (P<.043). Usual gait speed increased from 1.11 to 1.26 m/s (P<.014). Swing time variability was lower (better) in all but one patient, changing from 3.0% to 2.3% (P<.06). Scores on the SPPB also improved (P<.008). Interestingly, many of the improvements persisted even 4 weeks later. CONCLUSIONS: These results show the potential to enhance gait rhythmicity in patients with PD and suggest that a progressive and intensive treadmill training program can be used to minimize impairments in gait, reduce fall risk, and increase QOL in these patients.