脑深部电刺激术在帕金森病中的临床应用与研究进展  

Clinical applications and research progress of deep brain stimulation in Parkinson's disease

作　　者：孙金兴 林豪鹏 贾俊恒 李珍柯 张超[1] 吴倩倩[1] 李新钢[1] 李卫国[1] Jinxing Sun;Haopeng Lin;Junheng Jia;Zhenke Li;Chao Zhang;Qianqian Wu;Xingang Li;Weiguo Li(Department of Neurosurgery,Qilu Hospital,Shandong University,Ji'nan 250013,China)

机构地区：[1]山东大学齐鲁医院神经外科,济南250013

出　　处：《中华脑科疾病与康复杂志(电子版)》2024年第6期321-324,共4页Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)

基　　金：山东省重点研发计划(2022ZLGX03);工信部产业技术基础公共服务平台项目(2022189181);十四五国家重点研发计划(2022YFC240510);山东省重大科技创新工程(2022ZLGX03-6);关于应用多模态技术预测帕金森DBS术后效果的研究(6010123074)

摘　　要：帕金森病(PD)是一种渐进性的神经退行性疾病,具有运动症状和非运动症状。脑深部电刺激术(DBS)适用于药物治疗无法充分控制症状、难以保证良好生活质量的晚期PD患者,以及因多巴胺能药物产生严重不良反应(如异动症)的患者。DBS可根据患者的具体症状进行个性化治疗,针对基底节-丘脑通路中的不同节点开展治疗,这些节点对疾病的多种症状具有介导作用。丘脑腹中间核DBS在控制震颤方面的效果最突出,苍白球DBS在控制僵硬和异动症方面成效显著,而丘脑底核DBS能够同时对震颤、运动迟缓、僵硬和异动症进行治疗,并且可以减少患者的药物使用量,也是疾病晚期的首选治疗目标。DBS对肢体症状具有长期的治疗效果,但随着疾病的进展,非多巴胺能轴向特征对DBS的反应会逐渐变差。PD的DBS治疗具有很高的专业性,需要由运动障碍神经学家、功能神经外科医生、专业的DBS程控人员以及神经心理学家组成的多学科团队来对患者进行筛选和随访。本文围绕PD的病理机制,DBS的适用情况、疗效、不良反应及脑靶点展开述评,以期为DBS在PD治疗中的应用提供更全面的认识,推动该领域的进一步发展。Parkinson's disease(PD)is a progressive neurodegenerative disorder with both motor and non-motor symptoms.Deep brain stimulation(DBS)is applicable to advanced PD patients whose symptoms cannot be adequately controlled by medication and whose quality of life cannot be well guaranteed,as well as to those who have severe adverse reactions(such as dyskinesia)due to dopaminergic drugs.DBS can provide personalized treatment according to the specific symptoms of patients,and the treatment is carried out for different nodes in the basal ganglia-thalamus pathway,and these nodes play a mediating role in various symptoms of the disease.DBS of the ventral intermediate nucleus of the thalamus is the most effective in controlling tremors,DBS of the globus pallidus is significantly effective in controlling rigidity and dyskinesia,while DBS of the subthalamic nucleus can simultaneously treat tremors,bradykinesia,rigidity and dyskinesia,and can reduce the amount of medication used by patients,and is also the preferred treatment goal in the late stage of the disease.DBS has a long-term therapeutic effect on limb symptoms,but as the disease progresses,the response of non-dopaminergic axial features to DBS will gradually deteriorate.The DBS treatment of PD is highly specialized and requires a multidisciplinary team composed of movement disorder neurologists,functional neurosurgeons,professional DBS programmers,and neuropsychologists to screen and follow up patients.This article reviews the pathological mechanism,the applicability,efficacy,adverse reactions,and brain targets of DBS,in order to provide a more comprehensive understanding of the application of DBS in the treatment of PD and promote the further development in this field.

关 键 词：帕金森病 脑深部电刺激 丘脑底核 功能神经外科 

分 类 号：R742.5[医药卫生—神经病学与精神病学]