帕金森病脑深部电刺激术后冻结步态程控模式研究  

Study on programming for freezing of gait after deep brain stimulation in Parkinson's disease

作　　者：郑慧芬[1] 张利丽[1] 章文斌[2] 胡秀秀[1] 王琰 孙丰[4] ZHENG Hui-feng;ZHANG Li-li;ZHANG Wen-bin(Department of Geriatric Neurology,Brain Hospital AJfiliated to Nanfing Medical University,Nanfing 210029,China)

机构地区：[1]南京医科大学附属脑科医院老年神经科,210029 [2]南京医科大学附属脑科医院神经外科,210029 [3]东南大学生物科学与医学工程学院 [4]南京医科大学附属脑科医院神经内科,210029

出　　处：《临床神经病学杂志》2018年第5期344-347,共4页Journal of Clinical Neurology

基　　金：江苏省重点研发计划(社会发展)基金资助项目(BE2016614);南京市医学科技发展资金资助项目(YKK17128)

摘　　要：目的探讨冻结步态(FOG)的帕金森病(PD)患者脑深部电刺激(DBS)术后程控参数模式调整的方法及疗效。方法对本院收治的8例伴FOG的PD患者进行DBS术,其后进行程控参数调整。开机时采用高频单极程控模式,若无改善改用低频刺激,再无改善尝试采用交叉电脉冲模式。如患者低频刺激作用不能持续或不能耐受,改用高频-低频交替使用模式或交叉电脉冲模式。术后第13个月、24个月分别进行统一PD评定量表(UPDRS)、FOG量表(FOG-Q)和日常生活质量评定(PDQ-39)量表评分以判断患者疗效。结果 2例患者使用高频单极程控模式,4例患者采用交叉电脉冲模式,2例患者采用高频和低频交替使用模式。所有患者DBS术后13个月和24个月的UPDRS第Ⅱ部分的第14分项、FOG-Q、UPDRS第Ⅲ部分及PDQ-39评分均较术前明显下降(均P <0. 01)。所有患者DBS术后13个月与24个月之间各量表评分的差异无统计学意义(均P> 0. 05)。结论 DBS程控参数模式的个体化调整效果显著,值得推广。Objective To explore methods and effects of programming for freezing of gait （FOG） after deep brain stimulation （DBS） in patients with Parkinson＇s disease （PD）. Methods Eight PD patients with FOG were treated with DBS in our hospital, and then program parameters were adjusted. A high frequency and monopolar programming was carried out at the initial programming visit. If it had proven ineffective, lower frequency would be implemented. If lower frequency programming had proven ineffective or not remained or intolerable, low frequency and high frequency would be implemented alternately or interleaving stimulation would be implemented. Efficacy were evaluated 13 months and 24 months after operation by the unified PD rating scale （UPDRS）, FOG questionnaire （FOC-Q） and PD questionnaire-39 （ PDQ-39 ） scale. Results A high frequency and monopolar programming was implemented in 2 patients. Interleaving stimulation was implemented in 4 patients. Low frequency and high frequency was implemented alternately in 2 patients. The 14th of Part 11 of UPDRS, FOG-Q, Part m of UPDRS and PDQ-39 scores in all patients at 13 months and 24 months after DBS were significantly lower than those before the operation （all P 〈0. 01 ）. There were no significant differences of those scores between 13 months and 24 months ＇after DBS （ all P 〉 0. 05 ）. Conclusion The individualized adjustment programming of DBS is significantly effective and worth promoting.

关 键 词：帕金森病 脑深部电刺激 冻结步态 

分 类 号：R742.5[医药卫生—神经病学与精神病学]