双侧STN-DBS治疗中晚期帕金森患者运动症状短期疗效

Short-term Efficacy of Subthalamicnulei Electrical Stimulation on Motor Symptoms in Patients with Moderate or Advanced Parkinson 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(PD)患者术后1 a内开机未服药状态下运动症状以及震颤、肌强直2种突出症状的疗效.方法对2016年3月至2016年11月在昆明医科大学第一附属医院微创神经外科接受双侧STN-DBS治疗的中晚期PD患者于术前应用帕金森统一评定量表运动部分(UPDRS-Ⅲ)评价其临床情况,术后6月、12月定期随访.根据术前UPDRSⅢ的震颤评分和非震颤评分将患者分为震颤型、僵直迟缓型和混合型3组.应用随机区组设计方差分析比较3组患者术前和术后的UPDRS评分.结果22例患者术后随访满1 a,6个月、12个月在开机未服药状态下较术前UPDRSIII、僵直、震颤症状均改善(P<0.05),术后6月和术后12月的运动症状、震颤、僵直改善率分别为61.1%,70%,60.2%及71.3%,77.9%,72.5%.僵直迟缓型患者术后6个月、12个月的UPDRSIII、僵直评分改善(P<0.05),混合型患者3项评分均改善(P<0.001).结论双侧STN-DBS对中晚期PD患者运动症状改善显著,震颤症状改善最高;并在一定时间范围内,运动症状改善逐渐提高.对不同类型中晚期帕金森患者的运动症状有疗效.

Objective To study the effects of the lilateral stubthalamic nuclens（STN） deep brain stimulation（DBS） on motor symptoms in moderate or advanced patients 1 year after the surgery, especially the effects on the tremor and rigidity. Methods From March 2016 to November 2016, 22 moderate or advanced patients had undergone the surgery in our hospital and they were followed up to 1 year after the operation. All patients were evaluated by the motor part of Unified Parkinson’s Disease Rating Scale（UPDRS-Ⅲ） a week before surgery and 6 months and 12 months post-operation respectively. Based on the UPDRS-Ⅲ tremor and non-tremor scores in preoperative off period, patients were divided into tremor-dominant type（TDT）, rigidity slow type（ART）,and mixed type（MT）preoperatively. Analyis of variance of randomizaed block design was carried out to compare the UPDRS scores with preoperative and postoperative patients in three subtypes.Results After 1 year of follow up, for 22 patients in the condition of on stimulation off medication,UPDRS-Ⅲ score,tremor score and rigidity score reduced significantly 6 months and 12 months post-operation（P〈0.05）. 6 months and 12 months after the surgery, the improvement rate of UPDRS-Ⅲ, tremor and rigidity were 61.1%, 70%, 60.2% and71.3%,77.9%, 72.5%,respectively. UPDRS-Ⅲ score and rigidity symptom were significantly improved after the surgery in rigitity slow patients（P〈0.05）; and in mixed patients, UPDRS-Ⅲ score, tremor and rigidity symptoms were all gotten better after the surgery（P〈0.001）. Conclusion Bilateral STN-DBS can effectively ameliorate the motor symptoms of patients with moderate or advanced Parkinson’s disease in a short term,especially the effect on tremor; and the therapeutic effect on the motor symptoms is increased over a period of time. There are also effects on different types of Parkinson’s disease.