帕金森病外科治疗分析报告.ppt

运动功能 美敦力DBS治疗患者的运动技能 (UPDRS III，停药） 提高了53%， 相比而言， 那些仅接受最佳药物 治疗的患者的运 动机能仅提高了4% Title | Description * Title | Description * * *Humanitarian Device: Authorized by Federal Law for the use as an aid in the management of chronic, intractable (drug refractory) primary dystonia, including generalized and segmental dystonia, hemidystonia, and cervical dystonia, for individuals 7 years of age and older. * In the prospective, randomised, double-bind, crossover multi-center study conducted by the Deep-Brain Stimulation for Parkinsons Disease Study Group, 96 patients with advanced, drug-refractory PD underwent bilateral stimulation of the STN with Medtronic DBS? Therapy. Patients completed a home diary documenting their motor status during the 2 days before each visit. Three motor states were identified: poor mobility (‘Off’), good mobility without dyskinesia (‘On’ without dyskinesia), and good mobility with dyskinesia (‘On’ with dyskinesia). Assessments of the percentage of time with good mobility and without dyskinesia (‘On’ without dyskinesia) during the waking time increased from 27% at baseline to 74% at six months, a 3-fold gain. This was paralleled by a decrease in the percentage of time with poor mobility (‘Off’ state), from 49% to 19%. Deep-Brain Stimulation for Parkinsons Disease Study Group. “Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinsons disease.” N Engl J Med 2001; 345: 956–63. PD = Parkinson’s disease; STN = subthalamic nucleus; DBS = deep-brain stimulation 帕金森病外科治疗 西安交通大学医学院第一附属医院 神经外科 陈伟博士 帕金森病外科治疗 立体定向毁损手术； 脑深部电刺激治疗； 干细胞疗法； 立体定向毁损术 在左旋多巴发现以前便应用于帕金森病的治疗； 应用立体定向技术将毁损源准确引导至靶点，按照预定的要求对靶 点进行毁损，从而制造处毁损灶或对病灶产生治疗性损害的技术； 试图中断脑内的异常活动； 丘脑毁损术； 苍白球毁损术； 丘脑底核毁损术； 目前射频毁损技术临床应用较多； 立体定向毁损术 单侧毁损手术的近期疗效很好，可以缓解帕金森病患者手术靶点对侧肢体的肌僵直、运动迟缓和静止性震颤，对左旋多巴导致的“异动症”和痛性痉挛有很好的疗效。但对帕金森病的中线症状，如起步困难、步僵等症状改善不明显，手术后左旋多巴的量不能减少。其疗效可以持续1-2年，以后随着对侧肢体的症状加重，先前手术带来的好处逐渐会变得无足轻重。 如果进行双侧的毁损手术，可能带来不可预测的并发症，如吞咽、语言和平衡障