用18F-FDG PET研究双侧丘脑底核电刺激对帕金森病神经功能网络的影响

目的 应用18F-FDG PET显像研究双侧丘脑底核(STN)深部脑电极刺激(DBS)对晚期帕金森病(PD)患者神经功能网络的影响.方法 5例晚期PD患者行双侧STN DBS植入术.DBS术后6个月,每例PD患者分别于"开"(处于DBS刺激状态)、"关"(停止DBS刺激状态)状态下行18F-FDG PET静息显像,并对每例患者进行统一PD量表(UPDRS)运动评分.通过统计参数图2(SPM2)软件对图像结果进行数据分析,了解双侧STNDBS对脑葡萄糖代谢尤其是神经功能网络的影响.结果 双侧STN DBS使PD患者豆状核(苍白球)、双侧丘脑、小脑及远隔顶叶皮质的葡萄糖代谢降低,中脑及脑桥的葡萄糖代谢升高,"开"和"关"状态下PD相关模式(PDRP)评分分别为2.12±15.24及4.93±13.01,差异有统计学意义(P＜0.05);且随着临床症状的改善,PDRP评分呈下降趋势.结论 双侧STN DBS能够明显改善晚期PD患者的临床症状,其机制可能是通过调节整个神经网络实现.     

帕金森病丘脑底核场电位信号特征检测

目的动态检测与帕金森病治疗相关的丘脑底核场电位信号特征。方法基于小波包变换,对帕金森病患者丘脑底核局部场电位信号的同步化和模式特征进行分析,建立动态阈值判别模型,对丘脑底核功能状态进行判定。利用仿真实验优化检测方法参数,使用优化后的检测方法对服药前后患者丘脑底核场电位beta频段进行检测。结果帕金森病患者丘脑底核场电位信号beta频段中具有幅度高、随机程度低、规则程度高的特征模式。患者服药前后的比较结果表明药物对场电位信号的动态特性具有显著影响,且特征模式信号被检测出的总时间、次数、每次持续时间以及幅度等特征在患者服药后显著性降低。结论本文提出的方法可以动态检测出帕金森病患者特征模式信号,并量化患者脑功能状态。提供了一种可以作为实现自适应闭环深部脑刺激反馈判定依据的方法。     

个体化预测丘脑底核脑深部电刺激术治疗帕金森病患者近期预后列线图模型的构建与评价

目的 构建个体化预测丘脑底核脑深部电刺激术(subthalamic nucleus-deep brain stim,STN-DBS)治疗帕金森病患者近期预后的列线图模型,并评价该模型的临床准确性和适用性。方法 随机选取2015年1月1日—2022年1月1日于聊城市人民医院脑科医院功能神经外科行STN-DBS治疗的帕金森病患者,所有患者随访1年,剔除失访患者,根据药物关期Schwab&England日常生活活动量表(Schwab and England Scale,S&E)评分分为预后良好组(S&E评分>70分)和预后不良组(S&E评分≤70分),通过多因素Logistic回归分析导致脑深部电刺激术治疗帕金森病患者近期预后不良的独立危险因素,基于上述独立危险因素利用R语言构建列线图模型,利用Bootstrap法验证构建模型的预测准确性,利用受试者工作特征曲线验证构建的临床模型的预测效能,利用临床决策曲线评价构建的预测模型的临床获益性。结果 预后良好者组共50例,预后不良组共35例。通过多因素Logistics回归分析导致STN-DBS治疗帕金森病患者...     

帕金森病的丘脑腹中间核电生理特性及术中定位意义

目的 研究帕金森病患者丘脑腹中间核(Vim)的电生理特性,寻找应用微电极来确定丘脑腹中间作为核毁损术靶点的方法。方法 在对23例震颤型帕金森病患者进行的微电极引导选择性丘脑腹中间核毁损术中,比较Vim与其周围结构背景放电、放电幅度和放电频率的差异,比较运动觉神经元和震颤细胞对微刺激的反应。结果 腹中间核与腹外侧核、腹后核和内囊的背景放电和放电幅度不同,根据神经元在主动和(或)被动活动对侧肢体时放电是否变化,将震颤细胞分为两类,两类震颤细胞的分布及微刺激时引起对侧肢体震颤的变化情况存在明显差异。运动觉神经元和震颤细胞在微刺激时引起对侧肢体震颤的变化情况也存在明显差异。结论 微记录能确定Vim前界,联合应用微刺激和微记录才能迅速、准确的确定Vim后界及手术靶点内外侧界。毁损靶区应包括在主动和(或)被动活动对侧肢体时放电变化的震颤细胞和运动觉神经元。     

丘脑下核和苍白球直接靶向立体定位的最佳MRI方法

目的丘脑下核(STN)和苍白球(GPi)的明确认定对于这些结构的深部脑刺激(DBS)非常重要。本研究的目的正是比较各种MRI技术对STN和GPi的显示,并评价每种技     

50例苍白球和丘脑联合靶点毁损术治疗帕金森病的手术配合体会

帕金森病 (Ｐａｒｋｉｎｓｏｎ’ｓｄｉｓｅａｓｅ,ＰＤ)是一种慢性神经系统常见病 ,多发于中年以上人群。现在我院采用脑内苍白球侧部和丘脑腹外侧核区联合靶点毁损术治疗 5 0例帕金森病 ,达到较好的效果 ,现将 5 0例该手术配合体会总结如下。1　临床资料自 2 0 0 1年 3月～ 7月 ,共 5 0例ＰＤ患者接受了手术治疗 ,其中男性 39例 ,女性 11例 ,年龄 4 5～ 78岁 ,病程 1～ 2 8ａ,术前有高血压史 8例 ,糖尿病史者 3例。2　护理2 1　术前护理2 1 1　心理护理　根据患者的各种心理状态 ,我们以优质的服务态度对待患者 ,与患者及家属充分沟通。…     

丁苯酞治疗帕金森病合并抑郁症的临床效果

目的 探讨帕金森病合并抑郁症采用丁苯酞治疗的临床效果及对脑源性神经营养因子(brain-derived neurotrophicfactor,BDNF)、5-羟色胺(5-hydroxytryptamine,5-HT)、血清神经营养因子-3(serum nerve nutrition factor-3,NT-3)、C反应蛋白(C reactive protein,CRP)的影响.方法 选取2013年9月-2014年9月在我院接受治疗的80例帕金森病合并抑郁症患者,采用数字表法将患者分为对照组和观察组,每组40例.2组患者入院后均给予常规治疗,对照组患者给予美多芭和盐酸舍曲林片口服,观察组患者在对照组治疗的基础上给予丁苯酞软胶囊口服,疗程均为12周.对比2组临床治疗效果以及治疗前后汉密尔顿抑郁量表(HAMD)和帕金森统一分量表(UPDRS)评分、BDNF、5-HT、血清NT-3和CRP水平.结果 观察组临床总有效率与对照组相比明显较高,差异具有统计学意义(P＜0.05).观察组患者治疗后的HAMD评分和UPDRS评分与对照组相比明显较低,差异具有统计学意义(P＜0.05).2组患者治疗后的血清NT-3、BDNF、5-HT水平明显高于治疗前(P＜0.05),2组患者治疗后的CRP水平明显低于治疗前(P＜0.05);观察组患者治疗后的血清NT-3、BDNF、5-HT水平明显高于对照组,CRP水平明显低于对照组,差异具有统计学意义(P＜0.05).结论 丁苯酞可以明显改善帕金森病合并抑郁症患者的抑郁症状,明显降低血清CRP水平,明显提高BDNF、5-HT、血清NT-3水平,效果显著,建议推广.     

立体定向脑损毁术治疗帕金森病的研究进展

立体定向脑损毁术或称消融术(LT)是指通过立体定向微创技术损毁脑内特定组织结构从而治疗神经系统疾病的手术方法,主要包括磁共振引导超声聚焦消融术(MRgFUS)、伽马刀(GK)及射频消融术(RF)等.对于药物反应欠佳的帕金森病(PD)患者,LT可明显改善临床症状(如僵直、震颤、异动症等),减少药物用量,提高长期生活质量,...     

多模态影像技术在僵直少动型帕金森病的脑机制及TMS治疗中的研究进展

僵直少动型帕金森病(AR-PD)病人更易出现运动障碍且预后较差。多模态影像技术为评估PD病人大脑结构及功能改变提供了无创手段。经颅磁刺激(TMS)作为一种无创的治疗方法,可以通过改变刺激脑区的兴奋性达到改善PD运动症状的效果。总结AR-PD的临床特征,并就基于磁敏感加权成像、结构MRI、血氧水平依赖功能MRI和扩散张量成像等多模态MRI以及核医学技术对AR-PD的脑机制及其在AR-PD TMS治疗中的研究进展予以综述。     

Bilateral subthalamic stimulation improves gait initiation in patients with Parkinson's disease

Impaired gait initiation is one of the typical sign of advanced Parkinson's disease (PD). This is the first study to examine quantitatively the effect of deep brain stimulation of the subthalamic nucleus on the performance of gait initiation for patients with advanced PD. A total of 11 patients after surgery of bilateral deep brain stimulation of the subthalamic nucleus (STN) were tested in both the deep brain stimulation (DBS) ON and OFF conditions and/or in both the medication ON (i.e., with the usual dosage of antiparkinsonian medications administered) and OFF (i.e., with the usual dosage of antiparkinsonian medications withheld) conditions. DBS had no effect on the onset of anticipatory postural adjustment (APA). The effect of DBS approached significant level for the onset of swing foot lifting, but reached significant level for the delay of swing foot lifting. DBS significantly increased the amplitude of the APA, amplitude of reactive shear forces on both feet, and amplitude of COP in both anterior–posterior and medial–lateral directions. It is concluded that DBS significantly improved the performance of patients with advanced PD in gait initiation.     

3.0磁共振成像在丘脑底核靶点定位中的应用研究

目的:探讨3.0T磁共振成像(magnetic resonance imaging,MRI)在丘脑底核(subthalamic nucleus,STN)靶点直视定位的可行性及其临床效果。方法:采用不同场强的MRI技术对23例帕金森病患者进行STN靶点定位脑深部电极植入术。采用T2加权扫描,层厚2 mm,间隔0.5 mm,TE 150～200 ms,TR 4000～5000 ms,FOV33 cm2。结果:术前3.0TMRI能清晰可视STN等重要结构,能够在直视下STN靶点直接定位。3.0T组术中均出现微毁损效应,临床效果满意,术后MRI复查显示电极均位于相关靶点内。结论:3.0TMR能清晰显示STN结构的低信号区,可直视靶点定位,电极位置准确可靠。     

Effects of subthalamic nucleus stimulation and L-dopa in trunk kinematics of patients with Parkinson's disease

In the advanced phase of Parkinson's disease (PD), high frequency electrical stimulation (HFS) of the subthalamic nucleus (STN) can represent a good therapeutic option, whose effects on walking have been recently quantified by kinematic and dynamic gait analysis. The goal of the present study was to compare, in a group of PD patients, the effects of STN stimulation and of L-dopa on trunk kinematics during walking. The additive effect of these two treatments was investigated as well. Ten idiopathic PD patients implanted bilaterally with a STN stimulation system and ten age-matched controls were studied using a three dimensional motion analyser. Four conditions were considered: with (s+) and without (s-) STN stimulation and with (m+) and without (m-) L-dopa administration. The results showed that both stimulation alone and L-dopa alone significantly increased the stride length and the gait speed, with an additional effect if applied simultaneously. Cadence was more influenced by L-dopa. The range of lateral bending and torsion of the trunk, which were reduced in s-/m-, increased similarly in s-/m+ and in s+/m- conditions. The exaggerated forward inclination of the trunk reduced towards control values in all therapeutic conditions. There was a tendency for L-dopa to increase trunk movements in the frontal plane, similar to events seen in quiet stance. Due to the presence of additive and synergistic effects, we concluded that the mechanisms of action of the two treatments are likely to be different.     

Intraoperative functional MRI as a new approach to monitor deep brain stimulation in Parkinson's disease

This article deals with technical aspects of intraoperative functional magnetic resonance imaging (fMRI) for monitoring the effect of deep brain stimulation (DBS) in a patient with Parkinson's disease. Under motor activation, therapeutic high-frequency stimulation of the subthalamic nucleus was accompanied by an activation decrease in the contralateral primary sensorimotor cortex and the ipsilateral cerebellum. Furthermore, an activation increase in the contralateral basal ganglia and insula region were detected. These findings demonstrate that fMRI constitutes a promising clinical application for investigating brain activity changes induced by DBS.     

Long-term evaluation of gait initiation in six Parkinson's disease patients with bilateral subthalamic stimulation

Defined as the transient state between standing and walking, gait initiation is negatively affected in Parkinson's disease (PD), which often results in significant disability. Although deep brain stimulation (DBS) is the most common surgical procedure for PD, the long-term effects of DBS on gait initiation are not well studied. The present study evaluated the long-term effects of subthalamic nucleus (STN) DBS on the preparation phase of gait initiation using principal component (PC) analysis. Six patients with PD who had undergone STN DBS and 24 healthy control subjects were evaluated. PD subjects were assessed 11.3±10.3 (P1) and 78.9±10.6 (P2) months after surgery. PD subjects were tested with STN DBS in two conditions: without medication and with medication. PC analysis was applied separately for the vertical, anterior-posterior and medial-lateral components of ground reaction force (GRF) recorded during gait initiation. Three PC scores were chosen by the scree test for each GRF component and all these PC scores were used for calculating a standard distance between healthy controls and PD subjects. The Friedman test showed a significant difference in standard distance among conditions (P=0.004), with the post-hoc test recognizing differences among P1 conditions and P2 medication-on condition. The eigenvector loading factors pointed to major differences between PD conditions surrounding the maximum amplitude of vertical and anterior-posterior GRF. For the studied sample, all distances increased in the follow-up evaluation (P2) with and without medications, indicating a worsening in gait initiation after seven years.     

Ambulatory monitoring of left ventricular function in patients with Parkinson's disease and postural hypotension

Left ventricular (LV) function was continuously monitored using a radionuclide detector (VEST) after intravenous injection of 25 mCi technetium-99m labelled red blood cells in nine patients with Parkinson's disease and postural hypotension (group 1) and ten patients with Parkinson's disease but without postural hypotension (group 2). LV function and blood pressure were monitored in the supine position for 15 min (period A), upon changing posture from the supine to the upright position for 10 min (period B), and upon returning to the supine position for 10 min (period C). In group 1, the passage from period A to period B induced a significant decrease in end-diastolic volume, end-systolic volume and ejection fraction (allP<0.01). In group 2, ejection fraction increased (P<0.05) upon changing posture from the supine to the upright position. Ejection fraction (F=33,P<0.01), end-diastolic volume (F=9,P<0.05) and end-systolic volume (F=10,P<0.05) were significantly different between the two groups. In group 1, stroke volume, cardiac output and vascular peripheral resistance decreased from period A to period B (allP<0.001). In group 2, no changes in stroke volume, cardiac output and vascular peripheral resistance were observed from period A to period B. All parameters were similar in the two groups during the periods A and C. Upon changing posture from the supine to the upright position, patients with Parkinson's disease and postural hypotension showed marked changes in parameters of LV function induced by vascular abnormalities. The results of this study may help to clarify the potential risk of sudden postural changes in such patients, which may cause fainting, syncope and increased risk of ischaemic coronary and cerebrovascular attacks and of lower limb fractures.     

Changes in regional cerebral blood flow caused by deep-brain stimulation of the subthalamic nucleus in Parkinson's disease.

The aim of this study was to investigate the effect of deep-brain stimulation of the subthalamic nucleus (STN) on regional cerebral blood flow (rCBF) throughout the entire brain volume in patients with Parkinson's disease and to evaluate which of the brain areas showing an rCBF increase during STN stimulation related significantly to the improvement in motor function. METHODS: Ten consecutive Parkinson's disease patients (6 men, 4 women; mean age +/- SD, 59 +/- 8 y) with bilateral STN stimulators underwent 3 rCBF SPECT examinations at rest: the first preoperatively and the second and third postoperatively (follow-up, 4.8 +/- 1.4 mo) with STN stimulators on and off, respectively. The motor unified Parkinson's disease rating scale, the Hoehn and Yahr disability scale, and the Schwab and England activities-of-daily-living scale were used to evaluate the clinical state under each condition. Statistical parametric mapping was used to investigate rCBF during STN stimulation in comparison with rCBF preoperatively and with STN stimulators off. Also evaluated with statistical parametric mapping was the relationship between rCBF and individual motor scores used as covariates of interest. RESULTS: STN stimulation significantly changed rCBF in the right pre-supplementary motor area (pre-SMA), anterior cingulate cortex, and dorsolateral prefrontal cortex and in the medial Brodmann's area 8 (BA8) as defined in the atlas of Talairach and Tournoux (P < 0.05 corrected for multiple comparisons). The rCBF in these areas increased from the preoperative condition to the stimulators-on condition and decreased again after the stimulators were switched off. A significant correlation was detected between the improvement in motor scores and the rCBF increase only in the right pre-SMA and in the anterior cingulate motor area (P < 0.005, uncorrected). CONCLUSION: According to the topographic organization of the primate STN, our study shows that stimulation of the STN leads to rCBF increases in the motor (pre-SMA), associative, and limbic territories (anterior cingulate) in the frontal cortex. The significant correlation between motor improvement and rCBF increase in the pre-SMA and the anterior cingulate motor area reinforces the hypothesis that STN stimulation in parkinsonian patients can potentiate the cortical areas participating in higher-order aspects of motor control.