目的系统评价双侧丘脑底核脑深部电刺激术(subthalamic nucleus deep brain stimulation,STN-DBS)治疗帕金森病的临床疗效和副作用。方法通过检索国内外文献数据库,检索2009年4月前已发表的关于双侧STNDBS治疗帕金森病的临床研究,对所...目的系统评价双侧丘脑底核脑深部电刺激术(subthalamic nucleus deep brain stimulation,STN-DBS)治疗帕金森病的临床疗效和副作用。方法通过检索国内外文献数据库,检索2009年4月前已发表的关于双侧STNDBS治疗帕金森病的临床研究,对所纳入的研究进行系统评价。结果共纳入27项临床研究(纳入900例患者)。对随访1年病例进行meta分析,结果显示术后单纯STNDBS治疗与术前单纯服药治疗两种方案对UPDRSⅢ以及震颤、强直的改善无统计学差异(P>0.05);而STN-DBS治疗对UP-DRSⅡ、步态、运动迟缓改善不如术前服药(P<0.01);术后STN-DBS联合药物治疗对UPDRSⅡ、UPDRSⅢ以及震颤、强直、姿势稳定性的改善比术前服药治疗好(P<0.05),对运动迟缓、步态,联合治疗与术前药物治疗无统计学差异(P>0.05)。在STN-DBS副作用方面,手术导致颅内出血的发生率(3.7%)及死亡率(0.7%)等风险较低;较常见的为刺激导致的短暂的副作用:体重增加(18.8%)、构音障碍(14.9%)、睁眼困难(5.7%)、抑郁(8.2%)及智能减退(4.0%),大部分可经调节刺激参数后改善。结论STN-DBS联合药物治疗可显著改善帕金森病患者症状,并减少治疗药物的剂量以及药物所致的副作用;STN-DBS副作用较少,安全性高。展开更多
Objective: To assess the effects of focal motor cortex stimulation on motor pe rformance and cortical excitability in patients with Parkinsons disease (PD). Methods: Repetitive transcranial magnetic stimulation (rTM...Objective: To assess the effects of focal motor cortex stimulation on motor pe rformance and cortical excitability in patients with Parkinsons disease (PD). Methods: Repetitive transcranial magnetic stimulation (rTMS) was performed on th e left motor cortical area corresponding to the right hand in 12 offdrugpati ents with PD. The effects of subthreshold rTMS applied at 0.5 Hz (600 pulses) or at 10 Hz (2000 pulses) using a realor a shamcoil were compared to those obtained by a single dose of l dopa. The assessment included a clinical evalua tion by the Unified Parkinsons Disease Rating Scale and timed motor tasks, and a neurophysiological evaluation of cortical excitability by single and paired pulse TMS techniques. Results:RealrTMS at 10 or0.5 Hz, but notshamstim ulation, improved motor performance. High frequency rTMS decreased rigidity and bradykinesia in the upper limb contralateral to the stimulation, while low fre quency rTMS reduced upper limb rigidity bilaterally and improved walking. Concom itantly, 10 HzrTMS increased intracortical facilitation, while 0.5 HzrTMS restor ed intracortical inhibition. Conclusions: Low and highfrequency rTMS of the pri mary motor cortex lead to significant but differential changes in patients with PD both on clinical and electrophysiological grounds. The effect s on cortical excitability were opposite to previous observations made in health y subjects, suggesting a reversed balance of cortical excitability in patients w ith PD compared to normals. However, the underlying mechanisms of these changes remain to determine, as well as the relationship with clinical presentation and response to l dopa therapy. Significance: The present study gives some clues to appraise the role of the primary motor cortex in PD. Clinical improvement induc ed by rTMS was too short lasting to consider therapeutic application, but these results support the perspective of the primary motor cortex as a possible targe t for neuromodulation in PD.展开更多
文摘目的系统评价双侧丘脑底核脑深部电刺激术(subthalamic nucleus deep brain stimulation,STN-DBS)治疗帕金森病的临床疗效和副作用。方法通过检索国内外文献数据库,检索2009年4月前已发表的关于双侧STNDBS治疗帕金森病的临床研究,对所纳入的研究进行系统评价。结果共纳入27项临床研究(纳入900例患者)。对随访1年病例进行meta分析,结果显示术后单纯STNDBS治疗与术前单纯服药治疗两种方案对UPDRSⅢ以及震颤、强直的改善无统计学差异(P>0.05);而STN-DBS治疗对UP-DRSⅡ、步态、运动迟缓改善不如术前服药(P<0.01);术后STN-DBS联合药物治疗对UPDRSⅡ、UPDRSⅢ以及震颤、强直、姿势稳定性的改善比术前服药治疗好(P<0.05),对运动迟缓、步态,联合治疗与术前药物治疗无统计学差异(P>0.05)。在STN-DBS副作用方面,手术导致颅内出血的发生率(3.7%)及死亡率(0.7%)等风险较低;较常见的为刺激导致的短暂的副作用:体重增加(18.8%)、构音障碍(14.9%)、睁眼困难(5.7%)、抑郁(8.2%)及智能减退(4.0%),大部分可经调节刺激参数后改善。结论STN-DBS联合药物治疗可显著改善帕金森病患者症状,并减少治疗药物的剂量以及药物所致的副作用;STN-DBS副作用较少,安全性高。
文摘Objective: To assess the effects of focal motor cortex stimulation on motor pe rformance and cortical excitability in patients with Parkinsons disease (PD). Methods: Repetitive transcranial magnetic stimulation (rTMS) was performed on th e left motor cortical area corresponding to the right hand in 12 offdrugpati ents with PD. The effects of subthreshold rTMS applied at 0.5 Hz (600 pulses) or at 10 Hz (2000 pulses) using a realor a shamcoil were compared to those obtained by a single dose of l dopa. The assessment included a clinical evalua tion by the Unified Parkinsons Disease Rating Scale and timed motor tasks, and a neurophysiological evaluation of cortical excitability by single and paired pulse TMS techniques. Results:RealrTMS at 10 or0.5 Hz, but notshamstim ulation, improved motor performance. High frequency rTMS decreased rigidity and bradykinesia in the upper limb contralateral to the stimulation, while low fre quency rTMS reduced upper limb rigidity bilaterally and improved walking. Concom itantly, 10 HzrTMS increased intracortical facilitation, while 0.5 HzrTMS restor ed intracortical inhibition. Conclusions: Low and highfrequency rTMS of the pri mary motor cortex lead to significant but differential changes in patients with PD both on clinical and electrophysiological grounds. The effect s on cortical excitability were opposite to previous observations made in health y subjects, suggesting a reversed balance of cortical excitability in patients w ith PD compared to normals. However, the underlying mechanisms of these changes remain to determine, as well as the relationship with clinical presentation and response to l dopa therapy. Significance: The present study gives some clues to appraise the role of the primary motor cortex in PD. Clinical improvement induc ed by rTMS was too short lasting to consider therapeutic application, but these results support the perspective of the primary motor cortex as a possible targe t for neuromodulation in PD.
