丘脑底核脑深部电刺激对帕金森病焦虑状况的影响

目的探讨双侧丘脑底核脑深部电刺激(STN-DBS)对帕金森病人焦虑状况的影响。方法设置双侧STN-DBS组及左旋多巴类药物治疗组,配对入组,每组有效病例各31例。采用汉密尔顿焦虑量表(HAMA)、焦虑状态-特质问卷(STAI)、帕金森病生活质量39问卷(PDQ-39)及统一帕金森病评定量表第Ⅲ部分(UPDRS-Ⅲ)对病人进行评估分析。结果与术前及药物治疗组相比,STN-DBS组术后状态焦虑(S-AI)评分明显降低(均P<0.05)。STN-DBS组UPDRS-Ⅲ评分与S-AI评分在术后4个月内相关(均P<0.05),电压、脉宽与特质焦虑(T-AI)和HAMA评分均相关(均P<0.05);术后电压和脉宽对T-AI和HAMA评分的标准回归方程成立,回归系数均显著(均P<0.05)。结论 STN-DBS在改善帕金森病人运动障碍的同时,在短期内可改善即时焦虑情绪。在治疗范围内,STN-DBS电压和脉宽越高,帕金森病人的特质焦虑情绪和焦虑症状越严重。     

丘脑底核电刺激对帕金森病患者抑郁的疗效及抑郁与其他症状改善程度的相关性研究

目的探讨丘脑底核电刺激(STN-DBS)对帕金森病(PD)患者抑郁的疗效,并观察其与其他症状改善程度的相关性。方法对70例接受STN-DBS治疗的PD患者进行术前评估及12个月以上追踪,采用统一PD评定量表第三部分(UPDRSⅢ)、39项PD调查表(PDQ-39)、汉密尔顿抑郁量表(HAMD)评估患者运动症状、生活质量及抑郁水平,并记录患者PD药物服用情况。结果 PD患者接受STN-DBS治疗1年以上,其运动症状明显改善,PD相关生活质量提高,PD相关药物用量降低(均P0.001)。HAMD总分及七类因子分在STN-DBS治疗1年后均显著下降(均P0.05)。PD患者HAMD总分的改善程度与UPDRSⅢ药物"关"期改善及PDQ-39评分改善呈正相关(均P0.05)。各类因子分别与其他疗效相关分析可见:焦虑/躯体化与UPDRSⅢ药物"关"期改善及PDQ-39评分改善呈正相关(均P0.05);体质量减轻与药物减量呈负相关(P0.05);认知障碍、睡眠障碍及绝望感分别与PDQ-39评分改善呈正相关(均P0.001);阻滞与UPDRSⅢ药物"开"、"关"期改善及PDQ-39评分改善分别呈正相关(均P0.05);日夜变化与其他症状改善之间均无相关性。结论 STN-DBS治疗PD患者1年以上,可显著改善其抑郁障碍。且不同抑郁因子分的改善与生活质量、运动症状改善及药物减量间存在特异相关性。     

脑深部电刺激治疗对帕金森病患者认知功能、抑郁和焦虑的影响

目的探讨双侧丘脑底核脑深部电刺激治疗(STN-DBS)对帕金森病(PD)患者认知功能和抑郁、焦虑状态的影响。方法连续收集16例拟行双侧STN-DBS的PD患者为实验组,在术前1周、术后1月和术后3月行认知功能、抑郁和焦虑状态评估。同期在门诊收集16例优化药物治疗的PD患者为对照组,在相同时间点行同样的神经心理量表评估。结果实验组患者的Mo CA评分与术前(20.69±4.33)相比,在术后1月(19.81±4.34)及术后3月(19.44±5.35)均有下降趋势,但差异无统计学意义(P0.05)。实验组患者的抑郁症状与术前(23.56±14.60)相比,在术后1月(11.94±6.16)及术后3月(7.38±5.18)有明显改善(P0.05)。实验组患者的焦虑症状与术前(22.13±6.11)相比,在术后1月(15.13±5.62)及术后3月(8.00±6.76)有明显改善(P0.05)。抑郁焦虑的改善在任何时期均与UPDRS-Ⅲ无相关性(P0.05)。结论双侧STN-DBS治疗在术后3月时并不影响PD患者的总体认知功能,但各个认知域的改变需要更为详细的神经心理量表评估;双侧STN-DBS治疗在短期内可以显著改善PD患者的抑郁和焦虑症状,且抑郁和焦虑症状的改善与STN-DBS治疗后运动症状的改善无关。     

双侧丘脑底核脑深部电刺激术可改善中晚期帕金森病患者的症状

目的 探讨双侧丘脑底核(subthalamic nucleus,STN)脑深部电刺激(deep brain stimulation,DBS)术,对中晚期帕金森病(Parkinson's disease,PD)患者运动、生活质量、情绪、睡眠、认知及术后用药剂量的影响.方法 10例接受双侧STN-DBS治疗的中晚期PD患者分别于术前1周及术后3个月、6个月、12个月应用统一帕金森病评分量表(unified Parkinson's disease rating scale,UPDRS)、Hoehn&Yahr分级、帕金森病生活质量问卷(PDQ-39)、帕金森病睡眠评估量表中文版(PDSS-CV)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA),简易智能状态检查(MMSE)评价其临床情况,同时记录各时间点抗帕金森病药物的剂量及其变化,并对相关结果进行描述性分析.结果 10例PD患者术后均获得了显著疗效,震颤、肌强直、动作迟缓等都有明显改善,术后6个月开机未服药状态下改善率分别为68%、53%、35%,开机服药状态下改善率分别为86%、78%、69%,其中以震颤改善最为显著.术后UPDRSⅢ评分及Hoehn&Yahr分级均降低,术后6个月服药状态下改善率分别为67%、32%;日常生活质量提高,PDQ-39术后6个月改善率为71%,睡眠质量较术前改善,焦虑抑郁情况较术前有不同程度减轻,认知功能尤明显影响.抗帕金森病药物用量术后6个月较术前减少45%.结论 双侧STN-DBS能明显改善中晚期PD患者的运动症状及非运动症状.     

全麻下机器人辅助STN-DBS治疗高龄帕金森病的经验分享

目的 分析探讨高龄(>80岁)帕金森病(PD)患者全麻下机器人辅助双侧丘脑底核脑深部刺激植入术(STN-DBS)的安全性及有效性。方法 纳入2020年6月—2021年6月于首都医科大学三博脑科医院接受全麻下机器人辅助双侧STN-DBS治疗的3例高龄PD患者,回顾性分析其临床资料、手术过程并随访评估术后6、12个月的临床症状(UPDRS-Ⅲ开、关期评估运动症状、LEDD评估用药情况、H-Y分期评估症状严重程度)、神经心理预后(HAMA评估焦虑情绪、HAMD评估抑郁情绪)、认知预后(WAIS评估智力认知)及生活质量(ADL评估生活质量)。结果 3例高龄PD患者STN-DBS手术顺利,无严重术中或术后并发症,术后靶点验证植入误差均在0.7 mm以内。术后6个月及12个月评估时,运动症状、症状严重程度、焦虑抑郁情绪、生活质量均较前有显著改善,术后用药量显著减少,神经认知功能无显著变化;6个月随访数据与12个月数据基本无显著差异。结论 全麻下机器人辅助STN-DBS对高龄PD患者有较好的临床疗效,手术安全性基本可控,术后患者运动症状、药物减量、神经心理、生活质量均有显著改善且神经认知功能总...     

帕金森病脑深部电刺激术治疗的术后药物调整与程控配合

目的分析丘脑底核-脑深部电刺激术(STN-DBS)治疗帕金森病患者的术后程控工作及相关情况,为STN-DBS术后刺激参数的设置、药物的调整提供参考依据。方法病例选自2005年3月至2006年12月在北京天坛医院接受双侧STN-DBS植入术治疗的57例帕金森病患者。分析手术前后药物的用量和调整情况,评估不同刺激参数对震颤、运动徐缓和僵直等PD运动症状的改善作用。结果与术前相比PD患者DBS术后服用多巴胺类药物的剂量明显减少,术前平均707.59mg,术后平均253.62mg,平均减少63%,其中8例不再服用左旋多巴类药物。刺激频率为10Hz时无治疗作用,130Hz以上时症状可得到显著改善。除3例发生对侧肢体痉挛性收缩外,频率达到185Hz时能够获得最佳治疗效果。电压为2V-3V时可较好的改善运动,并随着电压值的增加治疗作用逐渐增强。结论本研究证实STN-DBS是一种安全、有效的治疗帕金森病的方法,STN-DBS能够显著减少左旋多巴类药物用量及药物引起的异动症、运动波动等并发症的发生。刺激电压是术后程控的主要调节参数。     

丘脑底核电刺激术对75岁以上帕金森病患者疗效

目的研究丘脑底核电刺激术(STN-DBS)对75岁以上帕金森病(PD)患者术后1年的疗效。方法选取2003年5月至2017年5月在我院接受STN-DBS治疗的10例75岁以上PD患者进行回顾性研究,分别于术前、术后3个月、6个月、12个月进行UPDRSⅢ及帕金森非运动评分。结果 10例患者术后随访1年,开机未服药与术前未服药状态相比,UPDRSⅢ、震颤、强直、迟缓及中轴症状评分均显著降低(P0.05)。术后1年帕金森患者非运动评分ADL、HAMD、PSQI评分显著降低(P0.05),MMSE、HAMA评分有所增加(P0.05)。结论STN-DBS能显著改善75岁以上PD患者的运动症状和部分非运动症状,提高患者生活质量,减少抗PD药物用量。但仍需长期随访以评价对高龄患者的疗效。     

帕金森病脑深部刺激治疗对认知和抑郁状态影响的队列研究

目的探讨帕金森病(PD)丘脑底核(STN)脑深部刺激治疗(DBS)对认知和抑郁状态的影响。方法连续的27例PD患者接受丘脑底核脑深部刺激治疗(STN-DBS)手术治疗,术前1周及术后6个月对认知和抑郁状态进行评估。结果术后6个月认知功能与术前认知、运动症状改善程度正相关。术后抑郁评分的改善程度与术前抑郁评分和运动症状改善程度正相关。结论在严格筛选手术适应证的前提下,STN-DBS可能对部分患者的认知功能有改善作用,并且不加重抑郁状态。     

双侧丘脑底核电刺激改善帕金森病患者关期运动障碍以及安全性评估

目的:探讨双侧丘脑底核电刺激(STN-DBS)改善帕金森病(PD)患者"关"期运动障碍疗效和安全性评估。方法:对接受双侧STN-DBS治疗的57例PD患者进行前瞻性研究。分别在术后1年和3年,应用UPDRS和Schwab&England评分对患者进行"关"期运动功能以及安全性评估。结果:与术前比较,在"关"期评分中,术后1年患者的运动功能评分改善60%;术后3年改善51%;除语言改善不明显外,震颤、肌肉强直、运动不能以及姿势稳定性等均有较大改善。术后3年多巴胺类药物的服用剂量、左旋多巴所致运动障碍的持续时间和严重程度都有明显减轻(P<0.001)。术后1年日常生活能力改善61%,术后3年改善50%。严重的不良事件为1例丘脑出血。结论:双侧STN-DBS治疗显著改善PD患者"关"期运动障碍,安全性好。     

丘脑底核脑深部电刺激治疗帕金森病合并抑郁障碍的长期疗效

目的研究丘脑底核（STN）脑深部电刺激（DBS）治疗帕金森病（PD）合并抑郁障碍的长期疗效并探讨其神经机制。方法对15例合并抑郁障碍的PD患者实施STN脑深部电极植入，术后3个月、6个月和12个月进行随访和临床评价。结果术后运动功能症状如肢体僵硬、震颤、运动迟缓和姿势平衡障碍改善良好，停药后PD分级量表运动评分显著下降（P〈0．01）。术后抑郁障碍症状如焦虑、绝望和激越症状改善良好，停药后汉密尔顿抑郁量表评分显著下降（P〈0．05）。结论STN-DBS能显著改善PD的抑郁障碍症状，STN在PD抑郁障碍神经机制中起重要作用。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -