脑深部电刺激治疗帕金森病和特发性震颤的近期和远期疗效

Short- and Long-term Efficacy of Deep Brain Stimulation in Parkinson' s Disease and Essential Tremor

自1987年以后,脑深部电刺激(deep brain stimulation,DBS)成为治疗难治性帕金森病和特发性震颤的主要外科手段。刺激的靶点最先为丘脑腹侧中间核(nucleus ventero-intermedius,Vim)。由于Vim DBS只能缓解震颤,而对于帕金森病的其他核心症状以及多巴长期应用后的不良反应,如运动波动和异动症疗效不显著,1990年后治疗PD的靶点转移到丘脑底核(subthalamic nucleus,STN)和苍白球内侧部(interal globus pallidus,GPi),上述问题在这两个靶点得到显著改善。Vim DBS仍然为治疗特发性震颤的位点。本文就这3个靶点的持续电刺激在治疗帕金森病和特发性震颤的近期和远期疗效等进行评述。

Deep brain stimulation has been the main surgical therapeutics for the patients of intractable Parkinson' s disease (PD) or of the essential tremor (ET) since 1987.The target of DBS in PD was firstly the thalamic ventero-intermedius nucleus (Vim) .Except for tremor, Vim DBS almost has very poor relief effects on the other cardical symptoms of PD,as well as the long-term side effects of levodopa,such as motor fluctuation and dyskinesia.Since 1990,the internal globus pallidus (GPi) and the subthalamic nucleus (STN) became the main targets in the PD patients while Vim DBS is now used in treatment of ET.The short- and long-term efficacy of GPi DBS and STN DBS in the patient with Parkinson's disease and that of Vim DBS in the patient with ET were veviewed.