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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 summarize the experience of post-procedure programmed control of Parkinson’s disease by subthalamic nucleus electrical stimulation in order to improve the postoperative program control and improve the curative effect. Methods Thirty-two patients with Parkinson’s disease after electrical stimulation of the subthalamic nucleus were programmed. Among them, 6 patients were unilateral implantation and 26 patients were bilateral. Aged 40-73 years old, patients underwent different stimulator implantation procedures, After 3 weeks to 4 years. Program-controlled before the withdrawal of more than 10h, the program-controlled parameters are mainly to stimulate the electrode contacts, voltage, frequency, pulse width of four, the process of close observation of patients with muscle tension and tremor and other symptoms and the occurrence of side effects, make a detailed record , Respectively, before and after treatment of patients with drug “off” and “open” symptom improvement, some UPDRS score. Results The postoperative symptoms of 31 patients (97%) were improved to some extent. Stimulation of the electrode contact selection, a total of 29 patients with unipolar mode, 3 cases due to sustained, unbearable side effects using bipolar mode. All patients used continuous stimulus except 1 in circulation. The stimulation voltage was 2.0 ~ 4.0V, mainly concentrated in 2.8 ~ 3.3V, which was the main parameter of program-controlled adjustment. The voltage level was not correlated with UPDRS motion score (P> 0.05). Stimulation pulse width 60 ~ 120μs, stimulation frequency 130 ~ 185Hz. Drugs “off” period, patients UPDRS motor score, with the stimulator on, an average of 18.7 points; stimulator off average 47.9 points. In the stimulator to open the case, the drug “open ” patients with symptoms are still further alleviated, mainly for the gait, the whole body coordination of action. Among the 6 patients with combined dyskinesia, 3 patients reduced the stimulus volume appropriately and 1 patient improved the voltage, and the patients with abnormal reaction relieved. Conclusion Subthalamic nucleus electrical stimulation is an effective control of Parkinson’s disease symptoms. Accurate implantation of stimulation electrodes is a prerequisite for obtaining good symptom control after surgery, and postoperative programmed control is a key step after deep brain stimulator implantation. Accurate parameter adjustment can satisfactorily control the patient’s symptoms.