帕金森病丘脑底核深部脑刺激术后参数的调整

Adjustment of postoperative parameters for deep brain stimulation of the subthalamic nucleus in Parkinson disease

目的探讨帕金森病丘脑底核深部脑刺激（DBS）术后脉冲发生器的参数调整。方法回顾性分析117例帕金森病病人的临床资料,均行丘脑底核DBS,单侧电极植入45例,双侧电极植入72例;并记录术后刺激参数的调整。结果刺激参数：双极刺激电压1～4 V,单极刺激电压1～3.6 V;脉宽60～90μs;频率130 Hz。统一帕金森病评定量表（UPDRS）运动评分的改善率,双侧刺激较单侧刺激明显（P〈0.05）。治疗后1~6个月,抗帕金森药物用量减少78例（66.7%）,维持术前水平39例（33.3%）。结论帕金森病丘脑底核DBS术后采用适当刺激参数可获得安全、可靠的疗效;电压调整对帕金森症状控制作用明显,脉宽及频率调整相对较少;双侧刺激效果优于单侧。

Objective To explore the parameter adjustment of impulsator after deep brain stimulation of the subthalamic nucleus（STN-DBS） in patients with Parkinson disease（PD）.Methods Clinical data of 117 PD patients undergoing STN-DBS were analyzed retrospectively.The electrode was implanted unilaterally in 45 patients and bilaterally in 72,and the adjustment of stimulation parameters after the operation was recorded.Results The stimulation parameter were as follows： the voltage ranged from 4 to 6 V for bipolar stimulation and 1 to 3.6 V for monopolar stimulation,pulse width from 60 to 90 μs,and frequency 130 Hz.According to UPDRS movement score,the improvement rate of bilateral stimulation was better than that of unilateral stimulation（P0.05）.One to six months after the treatment,the dose of antiparkinson medications decreased in 78 cases（66.7%）,and remained the preoperative level in 39（33.3%）.Conclusions Proper parameter settings of STN-DBS can gain safe and reliable therapeutic effects in PD patients.Voltage adjustment can markedly control PD symptoms,while adjustment of pulse width and frequency is less used relatively,and bilateral STN-DBS leads to better symptomatic improvement of PD.