丘脑底核脑深部电刺激术联合药物治疗帕金森病撤药恶性综合征二例报道  

Deep brain stimulation of subthalamic nucleus combined with drugs in two patients with Parkinson's disease related neuroleptic malignant syndrome

作　　者：邹志浩 雷哲 王晓军[2] 赵市伟 马俊严红艳 史有才[1] Zou Zhihao;Lei Zhe;Wang Xiaojun;Zhao Shiwei;Ma Jun;Yan Hongyan;Shi Youcai(Department of Neurosurgery,General Hospital of Xinjiang Military Region,Urumqi 830000,China;Department of Anesthesia,General Hospital of Xinjiang Military Region,Urumqi 830000,China;Lintong Rehabilitation Center of Shaanxi Province,Xi'an 710032,China)

机构地区：[1]新疆军区总医院神经外科,乌鲁木齐830000 [2]新疆军区总医院麻醉科,乌鲁木齐830000 [3]陕西省临潼康复疗养中心,西安710600

出　　处：《中华神经医学杂志》2019年第12期1268-1270,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨丘脑底核脑深部电刺激术(STN-DBS)在帕金森病(PD)撤药恶性综合征(NMS)治疗中的作用。方法回顾性分析新疆军区总医院神经外科2014年12月、2018年11月收治的2例NMS患者病史、症状特点,以及STN-DBS程控治疗过程及预后。结果2例患者发病前均有STN-DBS手术史,以及抗PD药物"减量"事件。入院时均表现为意识障碍、高热、原有症状的加重,以及肌酸磷酸激酶的增高,且上诉症状与感染转归不相关。入院后均给予补充抗PD药物及支持性治疗,同时多次调整STN-DBS刺激参数改善症状,其中例1最终参数调整为左侧(C+,2-、1-),脉宽110μs,频率200 Hz,强度3.8 V;右侧(C+,6-、5-),脉宽110μs,频率200 Hz,强度4.4 V;例2最终参数调整为左侧(C+,3-),脉宽60μs,频率130 Hz,强度2.0 V;右侧(C+,6-),脉宽80μs,频率160 Hz,强度2.8 V。2例患者均治愈出院,但随访6个月时患者仍存在运动功能障碍,生活自理能力严重受损。结论STN-DBS在NMS治疗中可能起到重要的协同作用。Objective To explore the role of deep brain stimulation of subthalamic nucleus(STN-DBS)in treatment of Parkinson's disease(PD)related neuroleptic malignant syndrome(NMS).Methods The medical history,clinical features,STN-DBS programmed treatment process and treatment results of two patients admitted to our hospital in December 2014 and November 2018 were retrospectively analyzed.Results Two patients with post-operative STN-DBS were evoked by dose-reduced treatment of anti-parkinsonian drugs,and presented with high fever,disorder of consciousness,aggravation of the original parkinsonism,and increase of creatine phosphokinase,which were not correlated with outcomes of infection.After admission,anti-parkinsonian drugs and other supportive therapies were supplemented;STN-DBS modulation were given to improve the symptoms;the final parameters of patient one were the left(C+,2-,1-),pulse width 110μs,frequency 200 Hz,and strength 3.8 V;the right side(C+,6-,5-),pulse width 110μs,frequency 200 Hz,strength 4.4 V;and those of patient two were the left(C+,3-),pulse width 60μs,frequency 130 Hz,strength 2.0 V;right side(C+,6-),pulse width 80μs,frequency 160 Hz,and strength 2.8 V.Both patients were cured,but their motor function and self-care ability were severely impaired.Conclusion STN-DBS may play an important role in the treatment of PD related NMS.

关 键 词：帕金森病 恶性综合征 撤药 丘脑底核 脑深部电刺激术 

分 类 号：R73[医药卫生—肿瘤] R742[医药卫生—临床医学]