脑深部电刺激治疗运动障碍性疾病的疗效观察

目的探讨脑深部电刺激（DBS）治疗运动障碍性疾病（MD）的疗效及安全性。方法对49例运动障碍性疾病的患者进行丘脑底核（STN）、苍白球内侧部（Gpi）、丘脑腹中间核（Vim）刺激电极植入术,术前采用1.0 TMR和3.0 TMR T2加权靶点扫描,在直视下行靶点直接定位。手术前后应用统一帕金森病评分量表评分（UPDRS）及Burke Fahn-Marsden运动障碍评分（BFMs）评价临床效果。结果本组手术前帕金森病患者UPDRS：药物＂关＂状态25-80分,平均55分;药物＂开＂状态19-53分,平均34分。术后在开机的情况下UPDRS：药物＂关＂状态17-24分,平均22分,改善率60.0%;药物＂开＂状态15-24分,平均19分,改善率44.0%。4例肌张力障碍患者BFMs平均改善率55.0%。41例患者术后症状迅速改善,肌张力降低,震颤及异动症消失。结论DBS能明显改善MD患者的临床症状,改善其生活质量,且具有安全性。

Clinical effectiveness of deep brain stimulation for movement disorder

ObjectiveTo explore the feasibility and clinical effectiveness of deep brain stimulation（DBS） for movement disorder.MethodsForty-nine consecutive patients with refractory movement disorder, of whom, 44 patients were Parkinson＇s disease, 4 dystonia and 1 essential tremor, received DBS from March 2002 to December 2012. The electrodes were implanted into the bilateral subthalamic nuclei（STN） of 43 patients with Parkinson＇s disease and 1 patient with dystonia, the bilateral globus pallidus of 1 patient with Parkinson＇s disease and 3 patients with dystonia, and the ventralis intermedius nucleus of 1 patient with essential tremor. All patients were followed up for 3-24 months. The unitified Parkinson＇s disease rating scale（UPDRS） and the Burke Fahn-Marsden scale（BFM）were used to assess the outcomes at the last follow-up.ResultsThe UPDRS score（17-24, mean 22） of patients with Parkinson＇s disease significantly improved compared with that（25-80, mean 55） before treatment on the condition of off-medication（P〈0.05）. The rate of improvement was 60.0%. While on-medication, the UPDRS score（15-24, mean 19） also significantly improved compared with that（19-53, mean 34） before treatment（P〈0.05）. The rate of improvement was 44.1%. One patient with dystonia failed, 2 recovered well 1 year after operation and 1 improved 6 months after operation. One patient with essential tremor improved after operation. The dysarthria occurred in 5 patients after operation. No intracranial hemorrhage occurred.ConclusionThe DBS is a feasible and effective treatment method for patients with movement disorder.