双侧丘脑底核电刺激对原发性帕金森病患者运动功能的改善作用

Amelioration action of electrostimulation on bilateral thalamic nuclei on the motor function in patients with primary Parkinson disease

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。

AIM： To evaluate the amelioration condition of movement function after the execution of deep brain stimulation on bilateral thalamus deep nucleus in the treatment of primary Parkinson disease patients and the effect on the dosage of bendopa. METHODS： Six Parkinson disease patients underwent chronic high frequency deep brain stimulation were selected from Department of Neurosurgery of New Bridge Hospital of Third Military Medical University of Chinese PLA between September 2003 and November 2004. The exciting electrode was implanted respectively in bilateral thalamus deep nucleus and synchronizedly embedded into the excitation generator with magnetic resonance imaging （MRI） led to stereo orientation method. One month after operation stimulation parameter was adjusted in vitro by long-distance control computer to achieve the best effect.Three months after operation the Parkinson disease association score was performed under open and close status respectively. The symptom amelioration of limb trembling, myotonus and hypokinesia etc. was evaluated by activities of daily living score. And the dosage of bendopa preparation was compared before and after operation. RESULTS： Six patients were all involved in the result analysis.① The 6 patients all gained the significant effect post-operation. The trembling disappeared completely. The myotonus, gait, posture obstacle and the complication induced by drug had significantly ameliorated. ② The beginning of the drug open status （meant when the drug was reacted, the activities of patients was freely） activities of daily living score, general score of unified Parkinson disease score scale and movement score： The open status of stimulator after chronic high frequency deep brain stimulation was significantly better than that at close status of stimulator [ （7.9±3.2）, （23.5±5.3） ; （37.8±3.4）, （45.2±5.4）; （30.5±3.1）, （42.1±5.4）points, （P〈 0.05-0.01）]. The activities of daily living score, general score of unified Parkinson disease score scale and movement score at drug close status： It was significantly better at open status of stimulator after chronic high frequency deep brain stimulation than that at close status of stimulator [（8.6±2.8）, （35.3±4.8） ; （42.6±4.9）, （78.4±7.7）; （35.2±4.7）, （70.7±6.8）points, （P〈 0.05-0.01）]. ③ The dosage of bendopa preparation： It was significantly lower 3 months after chronic high frequency deep brain stimulation than that before stimulation [（346.3±182.8）mg/d, （880.6±254.9）mg/d, （P 〈 0.01）]. CONCLUSION： The chronic high frequency deep brain stimulation in the treatment of Parkinson disease can significantly control the dyskinesia such as： limb trembling, myodystonia, gait and posture etc. and reduce the dosage of bendopa in patients.