帕金森病的脑深部电刺激治疗(2)
作者:佚名; 更新时间:2014-12-13
会带来严重的并发症。Blond报道14例VIM核的DBS治疗,9例(64%)震颤完全消失,11例(78%)功能改善。Benebiol报道46例DBS,62%病人震颤消失,88%明显改善。Benabid等[16]对2例严重PD患者进行STN刺激术,结果发现2例病人在刺激过程中肌强直和运动不能症状明显好转,肢体活动明显增大,灵活性提高。术后8个月随访,PD样症状消失,并彻底改善了多巴胺药物所致的“开-关”现象。最近Limonsin等[17]对伴有严重强直-运动不能型3例PD施行双侧STN刺激术,结果2例病人双侧僵直及运动不能症状明显缓解,肌张力障碍消失,且没有发现与刺激有关的并发症。故作者认为,STN高频电刺激术将是严重PD患者治疗的首选方法,并可能为运动迟缓和运动不能性PD治疗带来新的希望。Siegfried等[12]对3例严重PD患者施行双侧苍白球腹后外侧核电刺激治疗,术后症状立即消失,随访1年无复发,并已恢复正常生活,左旋多巴用量较术前减少50%以上。近来Lacono等[11]对1例左旋多巴治疗无效并伴有严重“开-关”现象的PD患者进行苍白球前部慢性电刺激治疗,发现同侧80%以上症状好转,对侧症状几乎完全消失,术后较术前减少药量75%。该作者认为苍白球前部慢性刺激术治疗PD有双侧肯定效果,且损伤小,并发症少。Ghika等[9]报道7例药物不能治疗的严重PD患者,对其行双侧慢性苍白球刺激术治疗,结果运动症状和生活能力改善50%以上,运动不能改善80%以上,2例震颤症状完全消失,其余均明显好转。该作者亦认为双侧苍白球植入DBS,安全性大,效果肯定,其最大优点是不进一步增加运动障碍等并发症。总之,无论是VIM、STN或GP的DBS治疗,刺激指标均可随病情的自然进展或药物的作用而进行调整,从而确保了对患者长期疗效的稳定性。这是DBS疗法优于毁损术的重要因素。
参考文献:
[1]Benabid AL.Long_term suppression of tremor by chronic stimula tion of the ventral intermediate thalamic nucleus[J].Lancet, 1991,337:403
[2]Bechereva NP.Method of eletrostimulation of the deep brain structure in treatment some chronic disease[J].Confin Neurol, 1975,37:136
[3]Brice J.Supprosion of intention tremor by contingent deep_brain stimulation [J].Lancet,1980,1:1 221
[4]Ohye C,Hirai T,Miyazaki M,et al.VIM thalamotomy for the treatment varionskinds tremor[J].Applied.Neurophysiology, 1982,45:275
[5]Hirain T,Miyazaki M,Nakajma H,et al.The correlation between tremor characteristics and predicted volume of effective lesions in stereotaxic nu cleusventralisintermedius thalamotomy[J].Brain,1983,106:1 201
[6]Andy OJ.Thalamic stimulation for control of movement disordersby chronic tereotaxic stimulation of the ventral intermediate thalamic nucleus[J].JNeurosurg,1992,77:62
[7]Limousine P,Pollak P,Benazzouz A,et al.Improvement in parkinsonian symptoms after bilateral subthalamic nucleus stimulation[J].Lancet,1995,345:91
[8]Tronnier VM,Fogel W,Kronenbuercer M,et al.Pallidal stimulation:an al ternative to pallidotomy[J].J Neurosurg,1997,87:700
[9]Ghika J,Villermuer J,Fankhauser H,et al.Effeciency and safety of bilateral contemporaneous pallidal stimulation(deep brain stimulation) in levodopare sponsive patients with Parkinson’s disease with severe motor fluctuations:a 2-years follow- up review[J].J Neurosurg,1998,89:713
[10]Blond S.Control of tremors and involuntary movement disorders by chronic stereotactic stimulation of the ventral interme diate thalamic nucleus[J].J Neurosurg,1992,77:62
[11]Iacono RP,Lonser RR,Maeda G,et al.Chronic anterior pallodal stimula tion for Parkinson’s disease[J].Acta Neurochirurgica, 1995,137:106
[12]Siegfried J,Lippita B.Bilateral chronic eletrostimulation of ventroposter plateral pallidum:a new therapeutic approach for alleviating all Parkinsinian symptoms[J].Neurosurgery,1994,35:1 126
[13]Limousine P,Pollak P,Benazzouz A,et al.Improvement in parkinsonian symptoms after bilateral subthalamic nucleus stimulation[J].Lancet,1995,345:91
[14]Deiber MP,Pollak P,Passingham R,et al.Thalamic stimulation and sup pression of parkinsonian tremor[J].Brain,1993,116:267
[15]Benabid AL,Pollak P,Gao D,et al.Chronic electrical stimulation of the VIM of the thalamus as a treatment of movement disorders[J].J Neurosug,1996,84:203
[16]Benabid AL,Pollak P,Gross C,et al.Acute and long_term effects of STN stimulation in PD[J].Stereotact Funct Neurosurg,1994,62:76
[17]Cooper IS.Chronic cerebellar stimulation and DBS in involuntary move ment disorders[J].Appl Neurphsiol,1982,45:209
[18]伦学庆,章翔,张延庆,等.高频电刺激丘脑底核治疗帕金森病的实验研究[J].中华老年医学杂志,1998,17(3):146
参考文献:
[1]Benabid AL.Long_term suppression of tremor by chronic stimula tion of the ventral intermediate thalamic nucleus[J].Lancet, 1991,337:403
[2]Bechereva NP.Method of eletrostimulation of the deep brain structure in treatment some chronic disease[J].Confin Neurol, 1975,37:136
[3]Brice J.Supprosion of intention tremor by contingent deep_brain stimulation [J].Lancet,1980,1:1 221
[4]Ohye C,Hirai T,Miyazaki M,et al.VIM thalamotomy for the treatment varionskinds tremor[J].Applied.Neurophysiology, 1982,45:275
[5]Hirain T,Miyazaki M,Nakajma H,et al.The correlation between tremor characteristics and predicted volume of effective lesions in stereotaxic nu cleusventralisintermedius thalamotomy[J].Brain,1983,106:1 201
[6]Andy OJ.Thalamic stimulation for control of movement disordersby chronic tereotaxic stimulation of the ventral intermediate thalamic nucleus[J].JNeurosurg,1992,77:62
[7]Limousine P,Pollak P,Benazzouz A,et al.Improvement in parkinsonian symptoms after bilateral subthalamic nucleus stimulation[J].Lancet,1995,345:91
[8]Tronnier VM,Fogel W,Kronenbuercer M,et al.Pallidal stimulation:an al ternative to pallidotomy[J].J Neurosurg,1997,87:700
[9]Ghika J,Villermuer J,Fankhauser H,et al.Effeciency and safety of bilateral contemporaneous pallidal stimulation(deep brain stimulation) in levodopare sponsive patients with Parkinson’s disease with severe motor fluctuations:a 2-years follow- up review[J].J Neurosurg,1998,89:713
[10]Blond S.Control of tremors and involuntary movement disorders by chronic stereotactic stimulation of the ventral interme diate thalamic nucleus[J].J Neurosurg,1992,77:62
[11]Iacono RP,Lonser RR,Maeda G,et al.Chronic anterior pallodal stimula tion for Parkinson’s disease[J].Acta Neurochirurgica, 1995,137:106
[12]Siegfried J,Lippita B.Bilateral chronic eletrostimulation of ventroposter plateral pallidum:a new therapeutic approach for alleviating all Parkinsinian symptoms[J].Neurosurgery,1994,35:1 126
[13]Limousine P,Pollak P,Benazzouz A,et al.Improvement in parkinsonian symptoms after bilateral subthalamic nucleus stimulation[J].Lancet,1995,345:91
[14]Deiber MP,Pollak P,Passingham R,et al.Thalamic stimulation and sup pression of parkinsonian tremor[J].Brain,1993,116:267
[15]Benabid AL,Pollak P,Gao D,et al.Chronic electrical stimulation of the VIM of the thalamus as a treatment of movement disorders[J].J Neurosug,1996,84:203
[16]Benabid AL,Pollak P,Gross C,et al.Acute and long_term effects of STN stimulation in PD[J].Stereotact Funct Neurosurg,1994,62:76
[17]Cooper IS.Chronic cerebellar stimulation and DBS in involuntary move ment disorders[J].Appl Neurphsiol,1982,45:209
[18]伦学庆,章翔,张延庆,等.高频电刺激丘脑底核治疗帕金森病的实验研究[J].中华老年医学杂志,1998,17(3):146