苍白球内侧部电刺激对帕金森病非运动症状的疗效研究

Effects of deep palladium electrical stimulation on non-motor symptoms of Parkinson s disease

目的:研究在帕金森病(PD)患者苍白球(GPi)内侧部脑深部电刺激(DBS)治疗对患者非运动症状(NMS)的影响。方法:收集苍白球内侧部脑深部电刺激(GPi-DBS)治疗的32例PD患者,采用非运动症状评分量表(NMSS)评估患者治疗前后主要NMS发生率,比较治疗前后NMS发生率、药物用量变化;分析NMS评分的相关因素;观察不良反应发生情况。结果:(1)本组PD患者术前平均出现8.1项NMS;(2)患者Hoehn-Yahr分级与NMS发生率呈正相关(P<0.01);(3)治疗后1个月,患者日间嗜睡、失眠和疼痛症状减轻,与治疗前比较,差异具有统计学意义(P<0.05);治疗后3个月和6个月,日间嗜睡、失眠和疼痛症状继续减轻,与治疗后1个月比较,差异具有统计学意义(P<0.05);同时,焦虑和语言流畅性好转;但是治疗后3个月和治疗后6个月比较,患者主要NMS发生率比较,差异无统计学意义(P>0.05);(4)GPi-DBS治疗后6个月,患者多巴胺药物使用剂量也显著下降,与术前比较,差异具有统计学意义(P<0.05)。结论:GPi-DBS治疗PD患者,短期内可以改善患者焦虑、疼痛、失眠、日间嗜睡和语言流畅性障碍等症状,并可降低患者多巴胺药物的使用剂量。

Objective:To investigate the effect of deep brain electrical stimulation(DBS)implantation of Pale Ball(GPi)on non-motor symptoms(NMS)in patients with Parkinson s disease(PD).Methods:32 cases of PD treated by GPi-DBS were collected,non motor symptom scale(NMSS)was used to evaluate the incidence of NMS before and after treatment,and compared the incidence of NMS and drug dosage before and after treatment,analyzed the related factors of NMS score,and observed the occurrence of adverse reactions.Results:8.1 NMS were found before operation in PD patients.The NMS score was significantly correlated with the patient s Hoehn-Yahr rating(P<0.01).One month after treatment,the symptoms of drowsiness,insomnia and pain were alleviated,the difference was statistically significant compared with before treatment(P<0.05).The symptoms of drowsiness,insomnia and pain continued to decrease at 3 and 6 months after treatment,and the difference was statistically significant compared with 1 month after treatment(P<0.05),at the same time,anxiety and language fluency improved.However,there was no significant difference in the incidence of NMS between 3 and 6 months after treatment(P>0.05).Compared with before,the dosage of dopamine in patients at 6 monthes after the treatment was decreased significantly,the difference was statistically significant(P<0.05).Conclusion:GPi-DBS can improve the symptoms of anxiety,pain,insomnia,daytime drowsiness,forgetfulness in PD patients in a short period of time,and reduce the dosage of dopamine drugs.