脑深部电刺激术治疗毁损术后帕金森病的疗效

Efficacy of deep brain stimulation for patients with Parkinson's disease after lesion surgery

目的探讨脑深部电刺激术(DBS)治疗苍白球或丘脑毁损术后帕金森病的疗效与安全性。方法回顾性分析2013年1月至2021年3月毁损术后复发或出现新症状而行DBS治疗的33例帕金森病的临床资料。DBS后6个月,采用统一帕金森病量表(UPDRS)运动功能(UPDRSⅢ)评分和生活能力(UPDRSⅡ)评分、H-Y分期、简明精神量表评分(MMSE)以及左旋多巴等效日剂量(LEDD)评估疗效以及用药情况;记录刺激频率、脉宽、电压、阻抗,并计算刺激能量。结果术后随访6个月~8.25年,未出现言语障碍、眼球活动障碍、偏瘫、颅内出血或梗死、癫痫发作、颅内感染病例,无硬件故障;5例因电池耗竭行脉冲发生器置换术。DBS后6个月,UPDRSⅢ评分、UPDRSⅡ评分、H-Y分期、LEDD均较术前明显降低(P<0.05),而MMSE评分较术前无明显变化(P>0.05);和非毁损侧相比,毁损侧肢体震颤评分改善率明显增高(P<0.05),但僵硬评分改善率、运动迟缓评分改善率均无明显变化(P>0.05);和非毁损侧相比,毁损侧刺激电压和刺激能量明显降低(P<0.05),但刺激频率、脉宽和阻抗无明显变化(P>0.05)。结论PD病人神经核团毁损术后复发或出现新症状,DBS是安全、有效的,毁损侧DBS后电刺激所需能量及电压更低。

Objective To investigate the efficacy and safety of deep brain stimulation(DBS)for the patients with Parkinson's disease after the thalamotomy or pallidotomy.Methods The clinical data of 33 patients with Parkinson's disease who received DBS from January 2013 to March 2021 due to the recurrence or new symptoms after the thalamotomy or pallidotomy were analyzed retrospectively.Six months after the DBS,the motor function(UPDRSⅢ)score,the living ability(UPDRSⅡ)score of the Unified Parkinson's Disease Scale(UPDRS),the H-Y stage,the Mini-mental State Examination(MMSE)score and the levodopa equivalent daily dose(LEDD)were used to evaluate the efficacy;the stimulation frequency,pulse width,voltage,impedance were recorded and the stimulation energy was calculated.Results The results of postoperative follow-up(range,6 months~8.25 years)showed no speech disorder,eye movement disorder,hemiplegia,intracranial hemorrhage,cerebral infarction,epileptic seizure,intracranial infection,and hardware failure.Five patients underwent pulse generator replacement due to the battery exhaustion.Six months after the DBS,UPDRSⅢscore,UPDRSⅡscore,H-Y stage,and LEDD were significantly lower than those before the operation(P<0.05),while MMSE score had no significant change(P>0.05);Compared with the side without the thalamotomy or pallidotomy,the improvement rate of limb tremor score was significantly increased(P<0.05),and the stimulation voltage and the stimulation energy were significantly reduced(P<0.05)in the side with the thalamotomy or pallidotomy,but the improvement rates of stiffness score and the slow movement score,and the stimulation frequency,pulse width and impedance did not change significantly(P>0.05).Conclusions DBS is a safe and effective treatment method for the PD patients due to the recurrence or new symptoms after the thalamotomy or pallidotomy.The energy and voltage are lower in the side with the thalamotomy or pallidotomy.