双侧丘脑底核脑深部电刺激治疗中晚期帕金森病疗效(术后2年随访)

Effects of Bilateral Subthalamic Nucleus Deep Brain Stimulation on Motor and nonmotor Symptoms in Patients with Moderate and Advanced Parkinson's Disease-A Two-Year Follow-up Study

目的研究双侧丘脑底核(STN)脑深部电刺激术(DBS)对中晚期帕金森病(PD)患者术后2年的疗效。方法对2006年8月至2011年10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定量表(UPDRS)、Hoehn&Yahr(H&Y)分级、帕金森病生活质量问卷(PDQ-39)、Schwab&England日常生活活动量表、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MOCA)、帕金森病睡眠评估量表中文版(PDSS-CV)等评价其临床情况;术后半年、1年及2年定期随访,同时记录各时间点抗PD药物的剂量及DBS的刺激参数。结果 16例患者术后随访满2年,开机未服药及开机服药状态与术前未服药状态相比,UPDRSⅢ、震颤、强直、迟缓及中轴症状得分均显著降低(P<0.05),而与术前服药状态相比差异无统计学意义。"关"期时间由术前(6.3±0.8)h/d缩短至(2.8±0.6)h/d(P=0.008),术后2年H&Y及PDQ-39显著降低,差异有统计学意义。非运动症状评分无明显差异。抗PD药物左旋多巴等效剂量减少了44.4%。刺激参数:电压由开机时的(1.6±0.2)V增加至(2.3±0.3)V(P=0.001);脉宽由开机时的(61.9±5.1)μs增加至(71.3±14.0)μs(P=0.007);频率由(131.7±5.6)Hz增加至(146.0±18.5)Hz(P=0.006)。结论 双侧STN-DBS术后2年对中晚期PD患者的运动症状疗效肯定,能有效减少抗PD药物用量,显著提高患者生活质量。手术安全性高,并发症少且可调控。

Objective To study the effects of the bilateral subthalamic nucleus （STN） deep brain stimulation （DBS）on motor and nonmotor symptoms in moderate or advanced Parkinsonian patients 2 years after surgery. Methods From August 2006 to October 2011, 33 consecutive patients with refractory motor fluctuations or dyskinesia had underwent the surgery in our hospital, and 16 of them were followed up two years after operation. All Patients were evaluated by Unified Parkinson＇ s Disease Rating Scale（UPDRS）, Hoehn＆Yahr stage（H＆Y）, Parkinson＇ s Disease Questionnaire （PDQ-39） as well as Mini Mental State Examination （MMSE） , Montreal Cognitive Assessment（MOCA）, Hamilton depression scale （HAMD）, Hamilton anxiety scale（HAMA）, Parkinson＇ s Disease Sleep Scale-Chinese version （PDSS-CV）, Pittsburgh sleep quality index （PSQI）, and recorded the dosage of anti-parkinsonian drugs a week before surgery and 24 months post-operation respectively. Results Sixteen patients had significant improvements in motor sympotoms. Compared with that in off medication state pre-operation, the scores of UPDRS m, tremor, rigidity, bradykinesia and axial symptoms re- duced significantly by 35.4%, 34.8%, 55.1%, 28.8%, 28.1% respectively in on stimulation off medication condition and by 66.4%, 81.8%, 75.7%, 64.4%, 57.8% respectively at on stimulation on medication status. Compared with that in on medi- cation condition pre-operation, UPDRS Ill score and subscores had no statistic difference in on stimulation off medication and on stimulation on medication conditions.The ＂off＂ duration decreased significantly from （6.3±0.8）h/d to （2.8±0.6）h/d （P=-0.008）.The H＆Y stage （off condition） decreased significantly and PDQ-39 declined significantly from 56.3 ±16.4 pre-operation to 28.5 ± 14.3 at 2 year follow-up. There was no significant difference in the scores of nonmotor symptom scales （including MMSE, MOCA, HAMD, HAMA, PDSS and PSQI）. The daily levodopa equivalent dosage （LEDD） of anti- parkinsonian medication was significantly reduced by 44.4% two years after operation（P 〈 0.001 ）. While the DBS parame- ter of voltage increased from （1.6±0.2）V to （2.3±0.3）V（P=0.001）, pulse width increased from （61.9＋5.1） μs to （71.3±14.0） μs （P=0.007）and frequency increased from （131.7±5.6） Hz to （146.0±18.5） Hz （P=-0.006）. Conclusions Bilateral STN DBS can significantly ameliorate motor symptoms without worsening nonmotor symptoms in the patients with moderate or ad- vanced Parkinson＇ s disease. STN DBS improves the quality of life and reduces LEDD. This procedure has the advantages of an excellent safety, minor side effects and easy control.