双侧丘脑底核脑深部电刺激治疗帕金森病  

Bilateral deep brain stimulation of the subthalamic nucleus in advanced Parkinson's disease

作　　者：孙伯民[1] 刘康永[1] 郎黎琴[1] 潘力[1] 李殿友[2] 凌至培[3] 刘道宽[1] 

机构地区：[1]上海华山医院功能神经外科中心,200040 [2]吉林大学第一医院神经外科 [3]安徽省立医院神经外科

出　　处：《中华神经外科杂志》2002年第1期8-11,共4页Chinese Journal of Neurosurgery

基　　金：安徽省自然科学基金资助项目 ( 990 446 16 )

摘　　要：目的　应用双侧丘脑底核脑深部电刺激 (DBS)治疗难治性帕金森病 (PD) ,并对其疗效作出评价。方法　对 7例帕金森病患者采用磁共振导向立体定向及术中电生理验证方法 ,将刺激电极分别植入丘脑底核 ,采用同期或分期植入刺激发生器。术后 1周用程控计算机在体外调整刺激参数 ,以达到最佳疗效。结果　 6例患者术后均获得了显著的疗效 ,震颤完全消失 ,肌强直、步态、姿势障碍以及药物所致的并发症明显改善 ,同时多巴胺类药物用量明显减少 ,1例曾接受双侧丘脑腹中间核及一侧苍白球毁损后的患者只得到了轻度改善。结论　DBS法治疗中晚期PD ,具有安全 ,副作用可逆转的优点 ,且可根据患者的不同状况及病情发展调节刺激参数达到最佳症状控制 ,完全控制震颤 ,明显改善肌张力障碍、步态、姿势等运动障碍及药物所致的并发症 ,另外多巴胺类药物的用量也明显减少。Objective To evaluate the efficacy of bilateral deep brain stimulation(DBS) of the subthalamic nucleus (STN) in the treatment of advanced Parkinson's disease (PD). Methods Seven patients with PD were underwent DBS, Electrodes placement targeting was determined by magnetic resonance imaging (MRI) and confirmed with electrophysiological method. Results Significant improvement in six partients post-operatively without any severe complications. The tremors disappear completely, rigidity restores normally, gait and posture improve obviously; one case underwent bilateral Vim and unilateral GPi lesions improved mildly. Especially, bilateral DBS of the STN may significantly decrease the dose equivalents of levodopa.Conclusions Bilateral stimulation of STN is associated with significant improvement in motor function in patients with advanced Parkinson's disease whose condition cannot be further improvement with medical therapy.

关 键 词：脑慢性深部电刺激 帕金森病 丘脑底核 治疗 

分 类 号：R742.5[医药卫生—神经病学与精神病学]