丘脑底核脑深部电刺激治疗原发性帕金森病的不良事件

The adverse events in patients with Parkinson disease following subthalamic nucleus deep brain stimulation

目的 观察原发性帕金森病（Parkinson disease,PD）患者行丘脑底核脑深部电刺激术（deep brain stimulation of subthalamic nucleus,STN DBS）的不良事件。方法 纳入行STN DBS的原发性帕金森病45例,收集患者一般临床资料,术后随访至3～9年,观察术后不良事件。结果 手术相关不良事件：微毁损效应44例、囊袋积液2例、颅内出血1例、嗜睡1例;未观察到任何装置相关不良事件;刺激或疾病相关不良事件：异动症15例、步态平衡障碍12例,焦虑抑郁状态6例,构音障碍与多巴胺失调综合征各4例,智能减退2例,少数患者出现体重增加、幻觉、睁眼困难等。7例患者因共存疾病死亡。结论 STN DBS大部分不良事件可以控制,术后个体化调整参数及药物,有利于减少STN DBS不良事件。

Objective To investigate the adverse events in Parkinson disease （PD） patients undergoing deep brain stimulation of subthalamie nucleus （STN DBS）. Methods Forty-five PD patients undergoing bilateral STN DBS surgery were included in the present study. We collected the demographic characteristics and the adverse events after the surgery. All the patients ranged from 3 to 9 years post-operatively. Results The adverse events related to the surgery： A ＂microlesion effect＂ was identified in 44 patients. There were two cases of subcutaneous seroma, one case of somnolence and a case of intracranial hemorrhage. No adverse events were related to DBS device. Events related to stimulation or disease： 15 patients experienced troublesome dyskinesia, 12 had gait deterioration and falls. Six patients experienced anxiety and depression. Four patients showed dysarthria and 4 experienced dopamine dysregulation syndrome. Two patients had hypophrenia. A small patients experienced weight gain, hallucination and apraxia of eyelid opening. Seven patients died of the comorbid disease. Conclusions Most adverse effects of STN DBS surgery might be minimized. To avoid the adverse events of STN DBS, stimulation parameters and medications should be adjusted individually after the surgery.