中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (2): 347-352.doi: 10.4103/1673-5374.226406

• 原著:退行性病与再生 • 上一篇    下一篇

单纯调整程控电压参数可改善接受脑深部电刺激治疗术后帕金森病患者的强直及震颤

  

  • 收稿日期:2017-10-26 出版日期:2018-02-15 发布日期:2018-02-15
  • 基金资助:

    广东省科技基金项目（2014A030304019），广东省自然科学基金项目（2015A030313164）

Voltage adjustment improves rigidity and tremor in Parkinson’s disease patients receiving deep brain stimulation

Shao-hua Xu1, Chao Yang2, Wen-biao Xian1, Jing Gu3, Jin-long Liu2, Lu-lu Jiang1, Jing Ye1, 4, Yan-mei Liu1, Qi-yu Guo1, Yi-fan Zheng1, Lei Wu1,
Wan-ru Chen1, Zhong Pei1, Ling Chen1   

  1. 1 Department of Neurology, National Key Clinical Department and Key Discipline of Neurolory, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
    2 Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
    3 Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, China
    4 Department of Neurology, Tangshan Worker’s Hospital, Tangshan, Hebei Province, China
  • Received:2017-10-26 Online:2018-02-15 Published:2018-02-15
  • Contact: Ling Chen, M.D., Ph.D.,chenl2@mail.sysu.edu.cn.
  • Supported by:

    This study was supported by the Science and Technology Foundation of Guangdong Province of China, No. 2014A030304019; the Natural Science Foundation of Guangdong Province of China, No. 2015A030313164.

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摘要：

丘脑底核深部电刺激是公认的治疗中晚期帕金森病的有效方法。术后程控是影响丘脑底核深部电刺激治疗效果的关键因素之一，其中电压被认为是最重要的参数。我们对中山大学第一附属医院进行双侧丘脑底核深部电刺激的6例年龄为37-65岁（4男2女）帕金森病患者进行了回顾性分析，总结术后1，2年单纯调整电压参数帕金森病患者统一帕金森病评定量表第三部分的评分、Hoehn-Yahr分期以及左旋多巴等效剂量。术后2年随访结果显示，当电压脉冲宽度维持在60μs频率为130Hz时，可以改善患者的强直及震颤症状，且临床症状较轻，尤对多参数程控调整出现不能耐受副作用的患者更为适用，术后1，2年时每日左旋多巴等效剂量较基线时大幅度减少。结果显示单纯调整程控电压参数可改善接受脑深部电刺激帕金森病术后患者的强直及震颤症状。该临床试验已在北美临床中心注册，注册号为NCT01934881。

orcid:0000-0002-6909-9606(Ling Chen)

关键词: 神经再生, 脑深部电刺激, 帕金森病, 丘脑底核, 电压, 脉冲宽度, 频率, 震颤, 强直, 运动迟缓, 中轴症状

Abstract:

Deep brain stimulation of the subthalamic nucleus is recognized as the most effective treatment for moderate and advanced Parkinson’s disease. Programming of the stimulation parameters is important for maintaining the efficacy of deep brain stimulation. Voltage is considered to be the most effective programming parameter. The present study is a retrospective analysis of six patients with Parkinson’s disease (four men and two women, aged 37–65 years), who underwent bilateral deep brain stimulation of the subthalamic nucleus at the First Affiliated Hospital of Sun Yat-sen University, China, and who subsequently adjusted only the stimulation voltage. We evaluated motor symptom severity using the Unified Parkinson’s Disease Rating Scale Part III, symptom progression using the Hoehn and Yahr scale, and the levodopa equivalent daily dose, before surgery and 1 and 2 years after surgery. The 2-year follow-up results show that rigidity and tremor improved, and clinical symptoms were reduced, while pulse width was maintained at 60 μs and frequency at 130 Hz. Voltage adjustment alone is particularly suitable for patients who cannot tolerate multiparameter program adjustment. Levodopa equivalent daily dose was markedly reduced 1 and 2 years after surgery compared with baseline. Our results confirm that rigidity, tremor and bradykinesia can be best alleviated by voltage adjustment. The trial was registered at ClinicalTrials.gov (identifier: NCT01934881).

Key words: nerve regeneration, deep brain stimulation, Parkinson’s disease, subthalamic nucleus, voltage, pulse width, frequency, tremor, rigidity, bradykinesia, axial symptoms, neural regeneration