双侧丘脑底核脑深部电刺激治疗中晚期帕金森病的疗效

Significant improvement of motor symptoms by deep brain stimulation of bilateral subthalamic nucleus in patients with moderate or advanced Parkinson＇s disease

目的 研究双侧丘脑底核（STN）脑深部电刺激（DBS）对中晚期帕金森病（PD）患者的疗效.方法 对2006年8月至2010年1月在中山大学附属第一医院接受双侧STN DBS治疗的中晚期PD患者于术前、术后分别应用统一帕金森病评分量表（UPDRS）、Hoehn＆Yahr（H＆Y）分级、帕金森病生活质量问卷（PDQ-39）、简易智能状态检查（MMSE）、帕金森病睡眠评估量表中文版（PDSS-CV）、匹兹堡睡眠质量指数（PSQI）及汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）等评价其临床情况 同时记录各时间点抗PD药物的剂量及DBS相关参数.结果 10例患者术后随访满1年,开机未服药及开机服药状态与术前未服药状态相比UPDRS-Ⅲ运动评分、震颤、强直、迟缓及中轴症状得分均显著降低,其中以震颤改善率最高（52.1%与77.7%）,与术前服药状态相比差异无统计学意义.觉醒状态＂关＂期时间由术前6.3 h/d缩短至1.8 h/d（P=0.008）,术后H＆Y分级及PDQ-39降低,差异均有统计学意义.非运动症状评分无明显变化.术后1年抗PD药物较术前显著减少49.2%.结论 双侧STN DBS术对中晚期PD患者的运动症状疗效肯定,能有效减少抗帕金森病药物用量,提高患者生活质量.手术具有安全性高、并发症较少且可调控的优点.

Objective To study the effects of deep brain stimulation （DBS） of bilateral subthalamic nucleus （STN） on the motor and non-motor symptoms in moderate or advanced Parkinson＇s disease （PD） patients. Methods From August 2006 to January 2010, 21 consecutive PD patients with refractory motor fluctuations or dyskinesia underwent operations at our hospital. All patients were evaluated by unified Parkinson＇s disease rating scale （UPDRS）, Hoehn ＆ Yahr （H＆Y） stage, Parkinson＇s disease questionnaire （PDQ-39）, mini mental state examination （MMSE）, Parkinson＇s disease sleep scale-Chinese vision（ PDSS-CV）, Pittsburgh sleep quality index （ PSQI）, Hamilton depression rating scale （HAMD） and Hamilton anxiety rating scale （HAMA）. And the daily dosage of dopaminergic agents was recorded at 1week pre-operation and 3, 6 and 12 months post-operation. Results Ten patients finished a 12-month follow-up. Their motor functions showed significant improvement. And the scores of UPDRS-motor, tremor,rigidity, bradykinesia and axial symptoms reduced significantly in the on-stimulation-off-medication condition and the on-stimulation-on-medication condition vs the on-medication condition pre-operation. And the improvement of tremor was the most pronounced （ 52. 1% and 77.7% respectively ） . The H＆Y stage decreased significantly from 3.2 ± 0. 7 to 2. 5 ± 0. 4 post-operation. The activities of daily living improved while PDQ-39 declined significantly from 56 ±9 pre-operation to 32 ± 13 at 12 months follow-up. The score changes of MMSE, PDSS-CV, PSQI, HAMA and HAMD were statistically insignificant. The levo-dopa equivalent dose of 1-year post-operation decreased significantly by 49.2% versus that of pre-operation （ P 〈0.05）. Conclusion Bilateral STN-DBS can significant ameliorate the motor symptoms of moderate or advanced PD patients, reduce the dosage of anti-PD medications and improve the quality of life. This procedure has the advantages of a greater safety, minor side effects and an easy controllability.