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目的:评价对原发性帕金森病患者实施双侧丘脑底核脑深部电刺激治疗后运动功能的改善情况,以及对左旋多巴用量的影响。方法:选择2003-09/2004-11在解放军第三军医大学新桥医院神经外科行双侧丘脑底核慢性高频脑深部电刺激的帕金森病患者6例。采用磁共振导向立体定向方法,将刺激电极分别植入双侧丘脑底核,同期植入刺激发生器。术后1个月用程控计算机在体外调整刺激参数,以达到最佳疗效。术后3个月分别在开、关状态进行帕金森病联合评分,日常生活活动评分评估肢体震颤,肌强直,运动减少等症状的改善。并对术前术后左旋多巴制剂用量进行了比较。结果:6例患者全部进入结果分析。①6例患者术后均获得了显著的疗效,震颤完全消失,肌强直、步态、姿势障碍以及药物所致的并发症明显改善。②药物开状态时(指药物开始起作用时,患者活动自如)日常生活活动评分、统一帕金森病评定量表总评分、运动评分:慢性高频脑深部电刺激术后刺激器开状态均明显优于刺激器关状态[(7.9±3.2),(23.5±5.3)分;(37.8±3.4),(45.2±5.4)分;(30.5±3.1),(42.1±5.4)分,(P<0.05～0.01)]。药物关状态时日常生活活动评分、统一帕金森病评定量表总评分、运动评分:慢性高频脑深部电刺激术后刺激器开状态均明显优于刺激器关状态[(8.6±2.8),(35.3±4.8)分;(42.6±4.9),(78.4±7.7)分;(35.2±4.7),(70.7±6.8)分,(P<0.05～0.01)]。③左旋多巴制剂的用量:慢性高频脑深部电刺激后3个月时明显低于刺激前[(346.3±182.8)mg/d,(880.6±254.9)mg/d,(P<0.01)]。结论:慢性高频脑深部电刺激治疗帕金森病,可明显控制肢体震颤,肌张力障碍、步态、姿势等运动障碍,减少患者左旋多巴的用量。
OBJECTIVE: To evaluate the improvement of motor function in patients with primary Parkinson’s disease after bilateral deep subthalamic nucleus stimulation and the effect on levodopa dosage. Methods: Six patients with Parkinson’s disease were selected from the Department of Neurosurgery, Xinqiao Hospital, Third Military Medical University, Third Military Medical University from September 2003 to November 2004. Using magnetic resonance guided stereotactic method, the stimulation electrodes were implanted into the bilateral subthalamic nuclei, implanted with stimulation generator. One month after operation, program-controlled computers were used to adjust stimulation parameters in vitro to achieve the best therapeutic effect. Three months after surgery, the Parkinson’s disease joint score was assessed in open and closed states, and scores of activities of daily living were evaluated for improvement of symptoms such as limb tremor, myotonia and decreased motion. Preoperative and postoperative levodopa dosage were compared. Results: All 6 patients entered the result analysis. ① Six patients achieved significant effect after operation, tremor completely disappeared, muscle rigidity, gait, posture disorders and drug-induced complications improved significantly. (2) When the drug was in the open state (referring to the patient when the medicine started to work freely), the activity score of daily living, the unified score of Parkinson’s disease rating scale and the score of exercise: The stimulator state of chronic HFEP was obvious (P <0.05), which was significantly higher than that of stimulator ([7.9 ± 3.2], (23.5 ± 5.3) points, (37.8 ± 3.4), (45.2 ± 5.4) points, (30.5 ± 3.1), (42.1 ± 5.4) ~ 0.01)]. Scores of daily living activities at drug off state, total Parkinson’s disease rating scale and motor score were significantly higher than those at exciter status [(8.6 ± 2.8) vs. (35.3 ± 4.8), (42.6 ± 4.9), (78.4 ± 7.7) points, (35.2 ± 4.7) and (70.7 ± 6.8) points respectively (P <0.05-0.01). (3) The dosage of levodopa preparation was significantly lower than that before stimulation [(346.3 ± 182.8) mg / d, (880.6 ± 254.9) mg / d, P <0.01] at 3 months after deep brain stimulation. . CONCLUSION: Chronic high-frequency deep brain stimulation of Parkinson’s disease can significantly control limb tremor, dystonia, gait and posture disorders and reduce the dosage of levodopa.