双侧丘脑底核交叉电脉冲脑深部电刺激对帕金森病步态障碍的疗效观察

Effects of interleaved programming of bilateral subthalamic nucleus-deep brain stimulation in gait disorder from Parkinson's disease

目的评价双侧丘脑底核(STN)交叉电脉冲脑深部电刺激(DBS)对帕金森病(PD)步态障碍(GD)的治疗效果。方法纳入南通市第四人民医院神经外科自2019年6月至2021年6月收治的35例行双侧STN-DBS治疗的PD患者为研究对象。所有患者采用交叉电脉冲DBS持续刺激3个月,其后转为单极DBS刺激3个月,通过世界运动障碍学会第三版统一帕金森病评估量表(MDS-UPDRS Ⅲ)评估患者运动症状的变化,起立行走试验(TUG)评估患者GD的治疗效果,帕金森病生活质量量表-39(PDQ-39)评估患者生活质量变化,并收集患者不良反应表现。结果35例PD患者采取交叉电脉冲DBS和单极DBS治疗后的MDS-UPDRS Ⅲ评分为(27.31±9.14)和(27.74±9.62)分,对比差异无统计学意义(P>0.05);交叉电脉冲DBS治疗后FOG-Q评分为(9.40±1.70)分,TUG步数(19.29±1.47)步,TUG时长为(10.97±1.40)s,PDQ-39评分分别为(59.46±1.71)分,均低于单极DBS治疗后[(12.54±1.99)分,(22.46±1.24)步,(13.97±1.24)s,(67.80±1.83)分],差异均具有统计学意义(P<0.05)。结论双侧STN交叉电脉冲DBS治疗可以明显改善PD患者的GD,有效提升患者的生活质量。

Objective To evaluate the effects of interleaved programming of bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) on gait disorder in Parkinson's disease (PD).Methods Thirty-five PD patients treated with PD with bilateral STN-DBS from June 2019 to June 2021 in the Neurosurgery Department of Nantong Fourth People's Hospital were included as the research objects. The two DBS modes of monopolar DBS and interleaved programming DBS were used for 3 months. The effects in motor symptoms were assessed by Movement Disorder Society-unified Parkinson's disease rating scale Ⅲ (MDS-UPDRS Ⅲ);the effects of gait disorder were assessed by Timed up and go (TUG) test;the effects of quality of life were assessed by the Parkinson's Disease Questionnaire (PDQ-39), and adverse reactions were collected.Results The MDS-UPDRS Ⅲ scores of 35 patients with PD after treatment with interleaved programming DBS and monopolar DBS were (27.31±9.14) and (27.74±9.62) respectively, with no significant difference (P>0.05);The FOG-Q score was (9.40±1.70) points, the number of TUG steps was (19.29±1.47) steps, the TUG duration was (10.97±1.40) s, and the PDQ-39 score was (59.46±1.71) points respectively after the treatment of interleaved programming DBS, which were lower than those after the treatment of monopolar DBS [(12.54±1.99) points, (22.46±1.24) steps, (13.97±1.24) s, (67.80±1.83) points], the differences were statistically significant (P<0.05).Conclusion Interleaved programming of DBS can significantly mitigate the gait disorder and improve the quality of life in PD patients, which is worthy of clinical promotion and application.