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目的 应用双侧丘脑底核脑深部电刺激 (DBS)治疗难治性帕金森病 (PD) ,并对其疗效作出评价。方法 对 7例帕金森病患者采用磁共振导向立体定向及术中电生理验证方法 ,将刺激电极分别植入丘脑底核 ,采用同期或分期植入刺激发生器。术后 1周用程控计算机在体外调整刺激参数 ,以达到最佳疗效。结果 6例患者术后均获得了显著的疗效 ,震颤完全消失 ,肌强直、步态、姿势障碍以及药物所致的并发症明显改善 ,同时多巴胺类药物用量明显减少 ,1例曾接受双侧丘脑腹中间核及一侧苍白球毁损后的患者只得到了轻度改善。结论 DBS法治疗中晚期PD ,具有安全 ,副作用可逆转的优点 ,且可根据患者的不同状况及病情发展调节刺激参数达到最佳症状控制 ,完全控制震颤 ,明显改善肌张力障碍、步态、姿势等运动障碍及药物所致的并发症 ,另外多巴胺类药物的用量也明显减少。
Objective To evaluate the therapeutic effect of bilateral deep subthalamic nucleus deep brain stimulation (DBS) on refractory Parkinson’s disease (PD). Methods Seven patients with Parkinson’s disease were implanted into the subthalamic nucleus using magnetic resonance guided stereotactic and intraoperative electrophysiological verification. The stimulation electrodes were implanted into the stimulation generator simultaneously or in phases. One week after operation, program-controlled computers were used to adjust stimulation parameters in vitro to achieve the best therapeutic effect. Results All patients achieved significant curative effect after operation, tremor disappeared completely, myotonia, gait, posture disorders and drug-induced complications were significantly improved. At the same time, the dosage of dopamine was significantly reduced. One patient who had received bilateral thalamus The patient with the abdominal core and the globus pallidus on one side had only a slight improvement. Conclusion DBS treatment of advanced PD, with safety, side effects reversible advantages, and according to patients with different conditions and disease development to adjust the stimulation parameters to achieve the best symptom control, complete control of tremor, significantly improve dystonia, gait, posture Other movement disorders and drug-induced complications, in addition to the amount of dopamine was also significantly reduced.