摘要：

目的 探讨脑深部电刺激术治疗苍白球或丘脑毁损术后帕金森病的可行性与疗效，并分析其治疗策略。方法 选择2013年12月至2019年12月行神经核团毁损术后复发并再次行脑深部电刺激术的帕金森病患者共9例，观察术中、术后麻醉苏醒和随访期间不良事件，采用统一帕金森病评价量表（UPDRS）和日常生活活动能力量表（ADL）评价患者运动症状和日常生活活动能力改善情况。结果 9例患者分别行单侧（2例）或双侧（7例）丘脑底核电刺激术，于毁损灶同侧和对侧所记录到的细胞放电频率均在400~500 Hz，无明显差异；术后症状均得到明显改善，以双侧丘脑底核电刺激术疗效更佳，无一例于术中或术后发生严重并发症。术前UPDRS评分为115.56±26.17，术后开机刺激3个月后评分为32.56±9.08，运动症状明显改善，手术前后评分差异具有统计学意义（t=10.853，P=0.000）；术前ADL评分为38.56±6.09，术后开机刺激3个月为73.68±19.07，术后日常生活活动能力明显改善（t=10.850，P=0.000）。结论 对于单侧苍白球或丘脑毁损术后出现肢体僵直和（或）震颤症状的患者，只要丘脑底核解剖结构完整，择期行丘脑底核电刺激术安全有效，以双侧丘脑底核电刺激术效果更佳。

关键词: 帕金森病, 深部脑刺激法, 苍白球, 丘脑底核, 立体定位技术

Abstract:

Objective To investigate the feasibility and efficacy of deep brain stimulation (DBS) in the treatment of Parkinson's disease (PD) after pallidum or thalamus lesion, and to analyze its therapeutic strategy. Methods From December 2013 to December 2019, nine patients with PD whose symptoms recurred after nuclear lesion and underwent DBS were selected. MRI combined with microelectrode recording (MER) technology was used to locate the target, and patients were treated with DBS. The adverse events during and after awake anesthesia and postoperative follow-up were observed to evaluate the safety of operation, Unified Parkinson's Disease Rating Scale (UPDRS) and Activities of Daily Living Scale (ADL) were used to evaluate the improvement of postoperative symptoms and the efficacy of DBS. Results In this group of 9 patients, 2 patients were treated with unilateral subthalamic nucleus (STN)-DBS, the remaining 7 cases were treated with bilateral STN-DBS; the cell discharge frequency recorded on the ipsilateral and contralateral sides of the lesion was 400-500 Hz, without significant difference. There were no intraoperative and postoperative complications, and the symptoms of all patients were improved in varying degrees. After 3 months of stimulation, the UPDRS score of PD patients decreased from (115.56±26.17) score to (32.56±9.08) score, the difference was statistically significant (t=10.853, P=0.000); and the ADL score increased from (38.56±6.09) score to (73.68±19.07) score, the difference was statistically significant (t=10.850, P=0.000). There was no postoperative complication. Conclusions For PD patients who had undergone unilateral pallidotomy or thalamus lesion, if limb stiffness/tremor symptoms exist, as long as the STN nuclei have complete anatomical structure, selective STN-DBS assisted by MER is safe and feasible, and bilateral STN-DBS would be better.

Key words: Parkinson disease, Deep brain stimulation, Globus pallidus, Subthalamic nucleus, Stereotaxic techniques