脑深部电刺激治疗运动障碍性疾病

目的探讨脑深部电刺激(DBS)对帕金森病(PD)和肌张力障碍(dystonia)等运动障碍性疾病的治疗作用及手术方法。方法应用3.0TMRI和微电极导向技术及手术计划系统进行靶点定位,对40例PD病人和3例继发性肌张力障碍病人进行双侧丘脑底核(STN)电极植入。结果PD病人的主要症状有显著改善,服药量也明显减少,术前和术后UPDRS评分有显著差异;3例继发性肌张力障碍病人症状均有不同程度的改善,如以UDRS和BFMS作为评价指标,其中1例药物引起的迟发性肌张力障碍病人症状改善达90%以上;术后无严重及永久并发症。结论首次证实STN-DBS对继发性肌张力障碍是一种有效的治疗方法,双侧STN-DBS是外科治疗PD的首选方法,DBS对运动障碍性疾病的治疗已显示出良好的前景。

Deep brain stimulation for movement disorders

Objective To discuss the therapuetic effects and operative methods of deep brain stimulation in patients of movement disorders including Parkinson's disease and dystonia. Methods Under the guidance of 3.0 telsa MRI, microelectrode recording technique and surgiplan system, bilateral subthalamic nuclei electrodes implantation were performed in 40 patients with PD and 3 patients with secondary dystonia. Results Cardinal symptoms improved and dosage of levodopa taken decreased remarkably in PD patients after DBS. UPDRS scores before and after operation differs significantly. Symptoms improved in all 3 cases of secondary dystonia to some extent. Among them symptoms of one tardive dystonia case caused by antipsychotics improved up to more than 90 percent, taking UDRS and BFMS as evaluating criteria. No severe and permanent complication occurred after operation. Conclusions Bilateral STN-DBS was proved to be an efficacious treatment to dystonia for the first time and was the optimal surgical treatment to PD. DBS has already taken on a favorable perspective in the treatment of movement disorders.