丘脑底核高频刺激治疗帕金森病

Subthalamic nucleus stimulation for advanced Parkinson's disease

目的 :研究脑深部刺激 (DBS)对帕金森病 (PD)的治疗作用 ,观察术中丘脑底核 (STN)刺激对PD震颤、肌僵直、运动缓慢的缓解效果及对语言的影响 ,探讨植入刺激电极的最佳位置。方法 :17例帕金森病患者 ,利用MRI及微电极导向立体定向方法将刺激电极植入丘脑底核 ,其靶点 :X =11mm ,Y =- 1mm ,Z =- 7mm。术中予以高频刺激 (频率为 15 0Hz,脉宽为 15 0 μs,电压自 0 5V开始 ,逐渐增至 6～ 8V) ;其中有 2例进行了STN电极永久性植入慢性电刺激 ,术后随访 6～ 8月。结果 :17例术中刺激发现 ,STN中上部是其刺激、改善病人症状的最佳位置 ,而电极过深及过外则易引起言语障碍。 2例永久性植入慢性电刺激经随访观察对肌僵直的控制非常满意 ,对运动缓慢有明显改善 ,并减少美多巴的服药量 ,UPDRS运动评分下降 5 0 %。结论 :STN的高频刺激能改善PD的震颤、僵直、运动缓慢等主要症状 ,是PD慢性刺激的最理想靶点 ,其中上部是刺激效果的最佳位置。

Objective:To assess the specific effect and side effect of high-frequency deep brain stimulation of subthalamic nucleus (STN-DBS) in controlling the tremor,rigidity and bradykinesia of Parkinson's disease(PD),and to investigate the best portion of STN for electrode lead implanted.Methol:Seventeen patients with advanced PD were selected for STN-DBS.Surgery was performed under local anesthesia using Leksell model G frame.Implants were placed into STN using MRI-based stereotaxy,microelectrode recording,and intraoperative test stimulation.The coordinate of STN:x=11mm,y=-1mm,z=-7mm.The effect was evaluated by the neurologist;two patients had implanted permanent lead for chronic stimulation.Result:Intraoperative STN test stimulation strongly improved most of the parkinsonian symptoms and indicated that the middle-upper part of STN was best postion for placement of lead.It induced dysphasia if the lead was over deep and too lateral.Two patients with permanent chronic stimulation showed satisfactory improvement in rigidity and bradykinesia,and reduced medications of L-dopa.Conclusion:STN-DBS is effective for controlling cardinal symptoms of PD,the middle-upper part of STN is best place for lead.