有创神经调控方法治疗帕金森病步态障碍与平衡失调的研究进展

Advances in treatment of postural instability and gait difficulty in Parkinson's disease by invasive neuromodulation

脑深部刺激治疗中晚期帕金森病(PD)患者的运动症状,已经被广泛接受,成为公认的外科手术治疗方法,但对于PD的步态障碍与平衡失调,学者们的观点并不一致。对脑深部电刺激治疗新靶点以及新治疗模式的探索从未停止,同时脊髓电刺激技术也为PD的步态障碍与平衡失调打开了新的神经调控方向。至今为止,探索神经调控作用机制、靶点及刺激参数对症状改善的试验和实践不断进行。然而,对于适用患者的筛选、中晚期PD患者步态障碍与平衡失调、疗效随时间减退的问题,仍待解决。因此,本文就有创性神经调控技术针对中晚期PD步态障碍与平衡失调的靶点选择、治疗方法做一综述。

Deep brain stimulation for the treatment of motor symptoms in patients with advanced Parkinson's disease(PD)has been widely accepted as a recognized surgical treatment,but scholars do not agree on the gait impairment and balance disorders in PD.The exploration of new targets for deep brain electrical stimulation treatment as well as new treatment modalities has never stopped,while spinal cord electrical stimulation technology has opened up new neuromodulation directions for gait disorders and balance disorders in PD.To date,trials and practices exploring neuromodulation mechanisms of action,targets,and stimulation parameters for symptom improvement are ongoing.However,the issues of screening of applicable patients,gait disturbances,and balance disorders in patients with intermediate to advanced PD,and the diminishing efficacy over time remain to be addressed.Therefore,this article reviews the target selection and therapeutic approaches of invasive neuromodulation techniques for gait impairment and balance disorders in advanced PD.