双侧丘脑底核脑深部电刺激术可改善中晚期帕金森病患者的症状

The bilateral subthalamic nucleus deep brain stimulation can improve the symptoms in patients with moderate or advanced Parkinson's Disease

目的探讨双侧丘脑底核(subthalamic nucleus,STN)脑深部电刺激(deep brain stimulation,DBS)术,对中晚期帕金森病(Parkinson's disease,PD)患者运动、生活质量、情绪、睡眠、认知及术后用药剂量的影响。方法10例接受双侧STN-DBS治疗的中晚期PD患者分别于术前1周及术后3个月、6个月、12个月应用统一帕金森病评分量表(unified Parkinson's disease rating scale,UPDRS)、Hoehn&Yahr分级、帕金森病生活质量问卷(PDQ-39)、帕金森病睡眠评估量表中文版(PDSS-CV)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、简易智能状态检查(MMSE)评价其临床情况,同时记录各时间点抗帕金森病药物的剂量及其变化,并对相关结果进行描述性分析。结果10例PD患者术后均获得了显著疗效,震颤、肌强直、动作迟缓等都有明显改善,术后6个月开机未服药状态下改善率分别为68%、53%、35%,开机服药状态下改善率分别为86%、78%、69%,其中以震颤改善最为显著。术后UPDRSIII评分及Hoehn&Yahr分级均降低,术后6个月服药状态下改善率分别为67%、32%;日常生活质量提高,PDQ-39术后6个月改善率为71%,睡眠质量较术前改善,焦虑抑郁情况较术前有不同程度减轻,认知功能无明显影响。抗帕金森病药物用量术后6个月较术前减少45%。结论双侧STN-DBS能明显改善中晚期PD患者的运动症状及非运动症状。

Objective To study the effect of the bilateral subthalamic nucleus （STN） deep brain stimulation （DBS） on motor, quality of life, mood, sleep, cognition and dosage of antiparkinsonian medication in moderate or advanced Paikinsonian patients. Methods Ten consecutive patients with refractory motor fluctuations and dyskinesia were assessed using the Unified Parkinson＇s Disease Rating Scale（ UPDRS）, Hoehn＆Yahr stage, Parkinson＇s Disease Questionnaire （PDQ-39） , Parkinson＇s Disease Sleep Scale Chinese version（ PDSS-CV）, Hamilton Anxiety and Depression Scale（ HAMA and HAMD）, as well as Mini-Mental State Examination （MMSE） and the dosage of dopaminergic drugs was recorded a week before surgery and 3, 6, 12 months after the surgical procedure. Results Ten patients achieved significantly improvement in tremor, rigidity and bradykinesia. The improvement was 68%, 53% , 35% respectively six months after surgery in the on stimulation off medication condition, and 86%, 78%, 69% respectively in the on stimulation on medication state. UPDRS Ⅲ and Hoehn＆Yahr stage reduced by 67% and 32% respectively six months after operation in the on stimulation on medication condition. The quality of life improved markedly and the improvement rate of PDQ-39 was 71% six months after surgery. There was mild improvement in sleep, anxiety and depression but not cognition. The daily dosage of antiparkinsonian medication was significantly reduced by 45% six months after operation. Conclusions Bilateral STN-DBS can significantly improve the motor symptoms and non-motor symptoms in patients with moderate or advanced PD.