抽动秽语综合征18F-FDG PET显像研究

目的分析比较正常人和抽动秽语综合征(TS)手术前后18F-FDG PET显像,探讨TS发病机制及手术治疗的可行性。方法经临床确认为TS的患者18例,行单侧苍白球切开术。术前1d和术后3月,在相同条件下分别行18F-FDG PET显像。目视法观察双侧运动区、基底节和小脑的18F-FDG分布。半定量分析法计算各观察部位与小脑18F-FDG摄取量的比值。采用全面评估抽动严重程度的YGTSS量表,对所有患者手术前后病情进行量化评估,以判断手术后的症状改善率,同时与20例正常人的脑显像比较。结果正常对照组,双侧感觉运动区皮质、双侧基底节、双侧小脑的18F-FDG呈对称分布。与正常对照比较,18例TS双侧感觉运动皮质18F-FDG摄取明显增高(P<0.01),双侧基底节18F-FDG摄取减低(P<0.05)。手术前后比较,术后手术侧感觉运动区皮质的18F-FDG分布减低(P<0.01),而基底节无明显变化(P>0.05)。18例患者术后症状改善率在63%~77%。结论双侧感觉运动区皮质18F-FDG摄取明显增高,双侧基底节18F-FDG摄取减低,为TS的18F-FDG PET显像特征。苍白球切开术明显地改善了对侧肢体抽动症状,使手术侧感觉运动区皮质18F-FDG摄取减低。     

左旋多巴试验在帕金森病外科治疗中的价值

目的　介绍左旋多巴试验在PD外科治疗中的应用价值。方法　对 33例PD病人 ,在进行UPDRS评分和Webster评分后 ,作一次单剂量左旋多巴试验。先停药 12小时以上 ,然后 ,一次性口服左旋多巴 35 0mg ,每隔 30分钟对病人的状态评价一次 ,共计检查 30 0分钟 ;最后计算病人对左旋多巴的改善率。根据病人临床表现分别作Vim核或Gpi毁损术。 结果　左旋多巴的最大改善率分为 0 =0 % ,± =12 .5 % , =37.5 % , =5 0 % , =75 % , =10 0 %。本组最大改善率为 : 4例 , 8例 , 9例 , 12例。所有病人的手术结果均为良好。结论　左旋多巴试验是PD病人术前准备过程中的一项重要检查     

帕金森病核团毁损术疗效与并发症的关系

目的：进一步总结帕金森病的微电极导向苍白球腹后部毁损术和丘脑腹中间核毁损术疗效。方法：微电极导向立体定向核团毁损术治疗帕金森病患者300例。对近期进行的100例患者在手术靶点选择、手术方法、手术疗效和并发症等方面进行总结，并与早期进行的100例手术患者比较。结果：近期进行的100例患者手术效果较好，并发症发生率低。结论：根据患者症状选择合适的毁损术能提高手术疗效；对靶点采用磁共振成像（MRI）图像和座标相结合的定位方法,可减少个体差异引起的误差；适当减少微电极记录针道数，降低毁损温度，能减轻电极与脑组织粘连，减少脑出血等并发症。     

帕金森病苍白球和丘脑毁损术的手术方式选择与疗效关系

目的　总结帕金森病 (PD)苍白球和丘脑毁损术的术式的选择与疗效关系。方法　对 2 13例PD进行了微电极导向立体定向手术治疗 ,其中苍白球腹后部毁损术 (PVP) 171例 ;丘脑腹中间核 (Vim)毁损术 2 1例 ;同期同侧PVP和Vim毁损术 8例 ;同期双侧PVP 5例 ;分期双侧PVP8例。结果　术后UPDRS评分发现上述各种术式在“关”状态下和“开”状态下症状均有明显改善 ,改善率分别为 5 0 .8%～ 6 0 .8%和 2 8.7%～ 36 .6 % ,其中以多靶点毁损术为佳。同期双侧PVP发生明显构音障碍、吞咽困难 1例。结论　根据不同症状选择不同术式 ,同期双侧PVP术后易产生并发症 ,应慎重采用     

Simultaneous repetitive movements following pallidotomy or subthalamic deep brain stimulation in patients with Parkinson's disease

Patients with Parkinson's disease (PD) commonly exhibit difficulties performing simultaneous tasks and levodopa has been shown to improve the performance of these movements to a greater extent than movements performed in isolation. The aim of this study was to compare the effects of acute unilateral pallidal lesions (nine patients) and bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) (eight patients) with levodopa therapy (ten patients) on the performance of isolated versus bilateral simultaneous repetitive movements. The STN group was assessed with and without DBS both on and off levodopa. The two tasks employed were maximally paced button tapping (Tap) and wrist pronation-supination (WPS) movements. During the off drug state (12–14 h after the last oral dose of levodopa), the performance of simultaneous Tap and WPS movements in all three groups was significantly slower and more irregular than when each movement was performed in isolation. For example, WPS velocity decreased by at least 37% (P<0.05) with concomitant Tap. Following levodopa, pallidotomy or STN DBS, WPS velocity was increased during the simultaneous task to a greater extent than in the isolated task. All treatments also improved WPS velocity and increased the regularity of movement during concomitant Tap (P<0.01). The findings indicate that, like levodopa, surgical therapies can improve the performance of simultaneous tasks more than isolated tasks. These observations suggest that the excessive neuronal activity and/or abnormal firing patterns in the globus pallidus internus that is found in parkinsonian patients contribute to difficulties in the execution of complex motor tasks. Electronic Publication     

同期丘脑和苍白球切开术治疗合并特发性震颤的帕金森病

目的：研究合并特发性震擅(Essential tremor,ET)的帕金林病（Rarkinson‘s disease,PD)手术治疗的最佳术式,评估同期丘脑和苍白球开术的手术必要性、临床治疗效果、安全性及其适应证,探讨可能的治疗机制。方法：应用微电极导向立体定向技术,对16例合并ET的PD患者实施了同期单侧丘脑和苍白球切开术。采用UP－DRS评分法,对所有患者进行了术前和术后的病情评分,分析手术对患者的整体症状,特别是震颤症的改善情况及手术并发症的发生情况。结果：同期单侧丘脑和苍白切开术能全面改善患者的整体症状,手术对侧各种形式的震颤在“开、关”两种状态下均完全消失,改善率为100％,对震颤的治疗效果优于单纯苍白球切开术。同期丘脑和苍白球切开术与单侧苍白球切开术相比风险相当,无严重并发症发生。结论：同期丘脑和苍白球切开术治疗合并ET的PD患者是一种安全有效的治疗方案,适应证的合理选择和微电极导向技术的应用是手术成功的关键。     

Lesions in monkey globus pallidus externus exacerbate parkinsonian symptoms

To further define the role of the external segment of the globus pallidus (GPe) in the development of parkinsonian motor signs, two rhesus monkeys were made parkinsonian with the neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Behavioral assessments of bradykinesia and akinesia as well as single neuron recordings in the internal segment of the globus pallidus (GPi) were performed in both monkeys before and after ablating the sensorimotor portion of GPe. The effects of apomorphine on behavior and neuronal activity were also assessed in the parkinsonian monkeys before and after GPe ablation. We found that lesions in GPe exacerbated parkinsonian symptoms, altered neuronal activity in GPi, and reduced the therapeutic effects of apomorphine. These results support the hypothesis that GPe can influence GPi neuronal activity and is directly involved in parkinsonism. In addition, these data suggest that the inclusion of GPe in pallidotomy lesions for the treatment of Parkinson's disease can block the beneficial effects of antiparkinsonian medications and should be avoided.     

脑立体定向手术治疗Meige综合征二例报告并文献复习

目的 探讨立体定向深部脑刺激术( DBS)和脑内核团毁损术在Meige综合征(MS)中的临床应用.方法 2例患者术前均采用Burke - Fahn - Marsden肌张力障碍运动评分(BFMDRS),1例MS患者行双侧苍白球内侧核(GPi) DBS手术治疗,1例患者行单侧GPi射频毁损术治疗.结果 行双侧GPi - DBS患者术后随访1年改善达83.7％(BFMDRS评分由术前的22.5分减少为4分),随访2年改善率达69.1％左右(BFMDRS评分由22.5分减少为6分),疗效较为稳定.1例行立体定向右侧GPi毁损术,术后1周疗效明显,BFMDRS从28分减少到6分,改善达78.6％;术后3个月BFMDRS评分为15分,改善率为46.2％,术后6个月随访,所有症状恢复到术前水平.结论 双侧GPi - DBS对于传统治疗无效的Meige综合征患者是一种安全有效的治疗方法;对于不能接受DBS手术的患者,行苍白球或丘脑毁损手术也是值得推荐的一种方法.     

苍白球腹后部毁损术中的靶点解剖定位和电生理定位

目的 总结苍白球腹后部毁损术中的靶点定位方法。方法 采用MRI扫描，前50例用坐标定位法计算靶点坐标，平均记录2．6个针道微电极信号；后191例采用坐标定位和图像定位相结合的方法计算靶点坐标，平均记录1．3个针道微电极信号。结果 MRI图像能显示苍白球各部分、内囊及视束等结构。微电极记录可确认苍白球内侧部边界、视束等结构。前50例患者坐标调整的百分数明显高于后191例患者。结论 MRI坐标定位和图像定位相结合，减少了个体差异引起的误差，使解剖定位更加准确。微电极记录技术是MRI定位方法的必要补充。     

感觉性抽动的立体定向苍白球射频毁损术

目的研究分析22例Tourette综合征（TS）的感觉性抽动特点及实施单侧苍白球腹后部毁损术的治疗作用。方法对22例经过系统的精神科药物及心理行为治疗失败的TS患者实施立体定向苍白球射频毁损术,应用YGTSS评分量表和感觉性先兆问卷对运动性抽动和感觉性抽动进行评估。结果22例患者中18例（81.8%）有各种类型的感觉性抽动,位于头/面部者最多（72.2%）,术后感觉性抽动发作频率较术前均有所下降,YGTSS各项评分均显著下降（P〈0.01）,其中运动抽动的改善率最高。结论感觉性抽动是TS的常见症状,单侧苍白球腹后部毁损术能全面减轻TS各种症状,但远期疗效有待进一步观察。