摘要
目的总结丘脑底核电刺激治疗帕金森病术后程控经验,提高术后程控水平,改善疗效。方法对32例丘脑底核电刺激术后的帕金森病患者进行程控,其中单侧植入者6例,双侧26例;年龄40～73岁,在不同刺激器植入中心接受手术,程控时间术后3周至4年之间。程控前均停药10h以上,程控参数调整主要为刺激电极触点、电压、频率、脉宽四项,程控过程中密切观察病员肌张力和震颤等症状改变以及副反应发生情况,作好详细记录,并分别评估患者程控前后药物"关期"和"开期"症状改善情况,部分行UPDRS评分。结果31例(97%)患者术后症状得到不同程度改善。刺激电极触点选择中,共29例患者采用单极模式,3例因出现持续、无法耐受的副反应采用双极模式。除1位患者使用循环模式外,其他患者均使用持续刺激模式。刺激电压2.0～4.0V,主要集中于2.8～3.3V,是主要的程控调整参数,电压的高低与病人UPDRS运动评分不具有相关性(P>0.05)。刺激脉宽60～120μs,刺激频率130～185Hz。药物"关"期,患者UPDRS运动评分,在刺激器打开时,平均18.7分;刺激器关闭时平均47.9分。在刺激器打开情况下,药物"开"期患者症状仍然有进一步缓解,主要表现为步态、全身协调动作方面。合并异动患者6例中,3例适当降低刺激电量,1例提高电压后,异动缓解。结论丘脑底核电刺激术是有效的帕金森病症状控制手段。准确植入刺激电极是术后获得良好症状控制的前提条件,而术后程控是脑深部刺激器置入术后的关键环节,精确的参数调整能够满意控制病人症状。
Objective To enhance the level of postoperative programming and improve efficacies by summarizing and analyzing the experience of postoperative programming for patients undergoing subthalamic nucleus （STN） stimulation for the treatment of their Parkinson＇s disease （PD）. Methods A total of 32 cases undergoing STN stimulation for the treatment of their PD were treated with postoperative programming, among which 6 received unilateral implantation and 26, bilateral. The age of PD patients varied from 40 to 73 and these patients received operations at different implantation centers with different stimulators, duration of programming varying from 3 weeks to 4 years after implantation. No medication was applied over 10 h before programming, adjustment parameters for programming mainly included stimulation electrode contact, voltage, frequency and pulse width. During programming, responses to symptom control and side effects in patients were closely monitored; results were carefully recorded and changes in symptoms of patients during ＂off＂ and ＂on＂ time medication before and after programming were respectively evaluated; some patients also underwent the Unified Parkinson＇s Disease Rating Scale （UPDRS） assessment. Results Symptoms of 31 （97%） of the 32 cases were alleviated to a certain extent. Twenty-nine cases had the monopole stimulation and 3 had bipolar stimulation due to continuous and unbearable serious side effects. All cases had continuous stimulation except one who underwent cycling stimulation. The principal adjustment parameter of programming was stimulation voltage （2.0-4.0 V）, focusing on 2.8-3.3 V; the degree of voltage was not correlated with UPDRS scores in patients （P〉0.05）. The pulse width was within 60-120 us and stimulation frequency varied from 130 to 185 Hz. The average UPDRS score in patients without medication was 18.7 with stimulation and 47.9 without stimulation. Medication could further alleviate the symptoms in patients when the stimulator was on, mainly r
出处
《中华神经医学杂志》
CAS
CSCD
2007年第12期1217-1220,1223,共5页
Chinese Journal of Neuromedicine
关键词
帕金森病
丘脑底核电刺激
程控
Parkinsson＇s disease
Subthalamic nucleus stimulation
Programming
