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目的 研究脑深部电刺激 (DBS)对帕金森病 (PD)的治疗作用 ,观察术中丘脑底核(STN)刺激对PD震颤、肌僵直、运动缓慢的缓解效果以及对语言的影响 ,探讨电极在丘脑底核内的解剖位置与刺激效果的关系 ,以寻找植入刺激电极至STN的最佳位置。方法 2 6例帕金森病患者 ,利用MRI及微电极导向立体定向方法将刺激电极植入丘脑底核 ,其靶点 :X =11mm～ 13mm ,Y =- 1mm～ - 3mm ,Z =- 7mm。术中予以高频刺激 (频率为 130Hz～ 15 0Hz ,脉宽为 90 μs～ 15 0 μs ,电压自 0 5V开始 ,逐渐增至 8V) ;利用电极的不同触点分别进行刺激 ,根据刺激效果和副反应的出现情况 ,确定电极在STN中的最佳位置。其中有 3例进行了STN电极永久性植入 ,术后随访 6～ 14月。结果 2 6例术中刺激发现 ,STN背外侧部是电刺激的最佳位置 ,而电极过深及过外则易引起言语障碍。结论 STN的高频刺激能改善PD的震颤、僵直、运动缓慢等主要症状 ,是PD慢性刺激的最理想靶点 ,其背外侧部是刺激效果的最佳位置。
Objective To study the therapeutic effect of deep brain stimulation (DBS) on Parkinson’s disease (PD) and to observe the effect of subthalamic nucleus pulposus (STN) stimulation on PD tremor, muscle rigidity and slow motion and its influence on language. The relationship between the anatomic location and the stimulation effect in the subthalamic nucleus in order to find the optimal location for implanting the stimulation electrode to the STN. Methods Twenty six patients with Parkinson ’s disease were implanted with stimulation electrodes into the subthalamic nucleus by using MRI and microelectrode guided stereotactic method. The targets of X - ray irradiation were X = 11mm ~ 13mm, Y = -1mm ~ -3mm and Z = -7mm. Intraoperative high frequency stimulation (frequency of 130Hz ~ 15 0Hz, pulse width of 90 μs ~ 15 0 μs, the voltage from 0 5V, gradually increased to 8V); the use of different contacts of the electrodes were stimulated, according to the stimulation effect and The occurrence of side effects, to determine the optimal position of the electrode in the STN. Three of them were permanently implanted with STN electrodes and were followed up for 6-14 months. Results 26 cases of intraoperative stimulation found that the dorsolateral part of STN is the best place for electrical stimulation, and the electrode is too deep and over the outside easily lead to speech disorders. Conclusions High-frequency stimulation of STN can improve the main symptoms of PD, such as tremor, stiffness and slow motion. It is the best target of PD chronic stimulation, and the dorsolateral part of STN is the best stimulation site.