双侧丘脑底核电刺激对帕金森病患者脑局部糖代谢的影响

目的 研究双侧丘脑底核(subthalamic nucleus,STN)慢性电刺激术(deep brain stimulation,DBS)对晚期帕金森病(Parkinson's disease,PD)患者静止期脑局部糖代谢的影响,并探讨其作用机制。方法 对5例进行双侧STN的DBS治疗的晚期帕金森病患者,分别在术前以及术后1个月电刺激条件下,进行静止期18F-脱氧葡萄糖(FDG)/PET检查和UPDRS运动评分,并通过SPM99统计学软件进行数据分析,比较STN的DBS治疗对脑内代谢的影响。结果 双侧STN的DBS治疗使PD患者临床症状明显改善,同时脑局部糖代谢也发生了明显变化:双侧豆状核、脑干(中脑、脑桥)、双侧顶枕部、运动前区(BA6)及扣带回的脑代谢增加,双侧前额叶底部海马的脑代谢明显减少(P<0.05)。结论 双侧STN的DBS治疗可能通过兴奋STN轴突的方式,使其投射区域的基底上行和下行通路以及相应的皮层高级中枢的代谢改善,从而使PD患者的临床症状改善。

The effect of bilateral subthalamic nucleus stimulation on glocose metabolism of cerebrum in advanced Parkinson''s disease

Objective To study the effect of bilateral subthalamic nucleus (STN) stimulation on resting-state cerebral glucose metabolism of advanced Parkinson's disease, and investigate the mechanism of deep brain stimulation (DBS). Methods Five consecutive advanced Parkinson's disease patients with bilateral STN DBS underwent 2 times F-FDG/PET examinations at resting-state preoperatively and one month postoperatively with STN stimulation. The UPDRS motor scale was used to investigate regional cerebral metabolic rate of glucose (rCMRGlu) during STN stimulation in comparison with rCMRGlu preoperatively. Results STN stimulation significantly improved the clinical symptoms: rCMRGlu increased in left globus pallidus, upper brainstem (right midbrain) , bilateral parietal-occipital cortex, and decreased in the bottom of both prefrontal cortex ( P < 0.001). Conclusions Bilateral STN stimulation activated the projection axon from STN and improved the clinical symptoms of advanced PD patients, which perhaps by the way of improving both ascending and descending pathway from the basal ganglia and increasing the metabolism of higher-order motor control of parietal-occipital cortex.