双侧丘脑底核脑深部刺激术治疗帕金森病13例报告

目的 探讨双侧丘脑底核（STN）脑深部刺激术（DBS）治疗帕金森病的临床经验。方法 从2002年到2005年共完成了13例帕金森病的双侧丘脑底核DBS，根据STN解剖学定位，靶点的理论坐标值是X=11-13mm，Y=0-2mm，Z=0-4mm，通过立体定向技术在双侧丘脑底核植入刺激电极，并于锁骨下方植入脑深部电刺激器。结果 随访时间为6个月到3年，3例震颤为主病人的症状完全缓解，即震颤完全消失；僵直和运动迟缓为主要症状者的症状缓解程度达90％以上，其中以四肢肌肉僵直的效果较好，运动迟缓也有明显缓解，但是有1例病人双侧肢运动协调性差。所有患者植物神经功能症状有较明显改善，如便秘、流涎、出汗和浮肿等均有改善。结论 DBS治疗帕金森病，是帕金森病治疗的一个里程碑似的进步。它可以明显地缓解帕金森病的主要症状和体征，对运动迟缓、僵直和震颤等均有较理想的效果。

Parkinson's disease treated with deep brain stimulation of the bi-lateral subthalamic nucleus:report of 13 cases

Objective To investigate the mechanism and summary the clinical experience of Parkinson's disease (PD) treated with deep brain stimulation (DBS) of the bi-lateral subthalamic nucleus (STN). Methods 13 PD cases were treated with DBS of the bi-lateral subthalamic nucleus from 2002 to 2005 year. The main symptoms are tremor in 3 cases, and rigidity, dyskinesia showed in two-side extremities of 10 cases. The theoretic coordinate of anatomic target is X=11~13 mm,Y=0~-2 mm,Z=0~4 mm. The stimulate electrode and impulse generator were implanted to the STN guided by CRW stereotactic location system. Results All the patients have been followed up for about 6 months to 3 years. Based on the Unified Parkinson's Disease Rating Scale (UPDRS), the clinical symptoms were significantly improved in 3 cases with tremor and over 90% of the cases with rigidity and dyskinesia, while 1 case had still a poor motor coordination ability in bilateral extremities. The autonomic nerve function of all the patients had improved obviously, such as constipation, sialosis, diaphorisis, swelling, and so on. Conclusion STN DBS represents a milestone in the development of treating PD. It can significantly improve the main symptoms and signs of PD patients and achieve a satisfied curative effect on bradykinesia, rigidity, and tremor. Bi-lateral STN DBS is more effective than the unilateral.