丘脑底核电刺激改善帕金森病症状的电生理基础  

Electrophysiological study of symptomatic improvement by subthalamic stimulation on patients with Parkinson's disease

作　　者：田珊[1] 庄平[2] 李勇杰[3] 

机构地区：[1]首都医科大学宣武医院,100053 [2]北京市功能神经外科研究所,100053 [3]教育部神经变性病学重点实验室,100053

出　　处：《中华医学杂志》2007年第47期3321-3324,共4页National Medical Journal of China

基　　金：国家自然科学基金(30370473;30770746);北京市自然科学基金(7042027);首都医学发展基金(2002-3077)

摘　　要：目的探讨丘脑底核(STN)细胞电活动、脑深部刺激(DBS)电极触点位置与帕金森病(PD)症状改善的关系。方法19例 PD 患者在接受 STN DBS 治疗的同时采集细胞电活动和肢体EMG。应用单细胞分析、相关性检验探讨不同放电模式细胞活动与症状的关系,PD 综合量表进行术前和术后疗效评估。结果在278个 STN 神经元中发现与震颤相关(12.6%)的放电活动多分布在STN 上部,而紧张性(32.7%)和不规则(54.7%)放电活动多分布在 STN 下部,进一步比较 STN 上下部各类细胞的分布均有统计学意义(P<0.05)。对 DBS 刺激触点的疗效分析发现,上部触点对震颤改善显著,而下部触点对僵直和迟缓的改善明显。结论 STN 不同放电模式神经元与 PD 症状有内在联系。Objective To investigate the correlation of the neuronal activity in the subthalamic nucleus （STN）, active contacts of deep brain stimulation （DBS）, and clinical outcome of Parkinson＇s disease （PD）. Methods Nineteen patients with PD, 12 males and 17 females, aged （61 ＋ 8）, received STN DBS. Simultaneously microelectrode recording was performed in the STN and electromyography （EMG） was conducted on the selected muscles of contralateral limb during the surgery. Single unit analysis and cross-correlation test were carried out to study the neuronal pattern-related parkinsonian symptoms. All patients were evaluated with the unified Parkinson＇s disease rating scale （UPDRS） in ＂off＂ state pre- and post-operatively. Results Two hundred and seventy-eight STN neurons were identified in 29 trajectories. Among these neurons, 35 （ 12.6% ） fired at the same frequency as the tremor （ R = 0. 7, P 〈 0. 01 ） and was defined as ＂tremor cell＂ ; 91 （ 32.7% ） fired rapid tonic discharge, and 152 （ 54. 7% ） fired irregular neuronal discharge. Majority of the tremor cells （74. 3% , 26/35 ） were localized at the dorsal part of STN, while majority of the tonic discharge cells （59. 3% , 54/94） and irregular discharge cells （65.1%, 99/ 152） were distributed in the ventral part of STN were localized at the ventral part of STN （all P 〈 0. 05 ）. UPDRS showed that the tremor improvement rates of the stimulation contacts from those at the lower part to the those at the upper part of STN （0/4, 1/5, 2/6, and 3/7） were 50. 0% , 68. 9%, 83.2%, and 87. 4% respectively; the clinical rigidity improvement rates were 84. 6% , 82.4% , 69. 7% , and 55.2% ; and the clinical bradykinesia improvement rates were 66. 1%, 57.0%, 54. 1%, and 42. 1% respectively. Conclusion Different patterns of neuronal activity in STN are likely to associate with parkinsonian symptoms. The results provide the helpful information for selection of contacts of DBS and surgical therapy.

关 键 词：帕金森病 丘脑底核 电刺激疗法 微电极 

分 类 号：R742.5[医药卫生—神经病学与精神病学]