深部脑电刺激在帕金森病治疗中的应用进展
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摘要
帕金森病是神经变性疾病,首选左旋多巴类药物治疗,早期治疗效果良好,随着病程进展,左旋多巴类药物治疗效果逐渐减退,可出现异动症、剂末恶化和开-关现象等,最终药物治疗将无法改善症状,故晚期帕金森病患者需选择手术治疗。与内科治疗相比,深部脑电刺激可使晚期帕金森病患者的肌肉强直、静止性震颤和运动迟缓等主要临床症状得到明显改善,并能够显著减少多巴类药物的服药量。脑深部电刺激术是目前治疗帕金森病的主要手术方式,具有选择性好、靶点明确、无损伤、可逆、可调节、手术安全和并发症少等优点。
Parkinson's disease( PD) is a neurodegenerative disease,with levodopa drug as the first-choice treatment,which has good early but gradually declined treatment effect with the disease progression. Abnormal involuntary movenments,end of dose deterioration,on-off phenomenon and so on may occur,eventually drugs will not be able to improve the symptoms,so patients with advanced PD need surgeries. Compared with medical treatment,deep brain stimulation can signifi cantly improve the major clinical symptoms of advanced PD,such as rigidity,static tremor and bradykinesia,and significantly reduce the dosage of dopa drugs. Deep brain stimulation is currently the main surgical method for PD,which has the advantages of good selectivity,clear target,no damage,reversible,adjustable,safe and less complications.
Parkinson's disease( PD) is a neurodegenerative disease,with levodopa drug as the first-choice treatment,which has good early but gradually declined treatment effect with the disease progression. Abnormal involuntary movenments,end of dose deterioration,on-off phenomenon and so on may occur,eventually drugs will not be able to improve the symptoms,so patients with advanced PD need surgeries. Compared with medical treatment,deep brain stimulation can signifi cantly improve the major clinical symptoms of advanced PD,such as rigidity,static tremor and bradykinesia,and significantly reduce the dosage of dopa drugs. Deep brain stimulation is currently the main surgical method for PD,which has the advantages of good selectivity,clear target,no damage,reversible,adjustable,safe and less complications.
引文
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[2] Heinrichs-Graham E,Wilson TW,Santamaria PM,et al. Neuro-magnetic evidence of abnormal movement-related beta desynchro-nization in Parkinson's disease[J]. Cereb Cortex,2014,24(10):2669-2678.
[3] AulickáSR,Jurák P,Chládek J,et al. Subthalamic nucleusinvolvement in executive functions with increased cognitive load:A subthalamic nucleus and anterior cingulate cortex depth record-ing study[J]. J Neural Transm(Vienna),2014,121(10):1287-1296.
[4] Heinrichs-Graham E,Kurz MJ,Becker KM,et al. Hypersynchronydespite pathologically reduced beta oscillations in patients withParkinson's disease:A pharmaco-magnetoencephalography study[J].J Neurophysiol,2014,112(7):1739-1747.
[5] Herrojo Ruiz M,Rusconi M,Brücke C,et al. Encoding ofsequence boundaries in the subthalamic nucleus of patients withParkinson's disease[J]. Brain,2014,137(Pt 10):2715-2730.
[6] Yin Z,Cao Y,Zheng S,et al. Persistent adverse effects followingdifferent targets and periods after bilateral deep brain stimulationin patients with Parkinson's disease[J]. J Neurol Sci,2018,393:116-127.
[7] Benabid AL,Pollak P,Gross C,et al. Acute and long-term effectsof subthalamic nucleus stimulation in Parkinson's disease[J].Stereotact Funct Neurosurg,1994,62(1/4):76-84.
[8] Buhmann C,Gerloff C. Could deep brain stimulation help withdriving for patients with Parkinson's?[J]. Expert Rev MedDevices,2014,11(5):427-429.
[9] Kim M,Cho KR,Park JH,et al. Bilateral subthalamic deep brainstimulation is an effective and safe treatment option for the olderpatients with Parkinson's disease[J]. Clin Neurol Neurosurg,2018,173:182-186.
[10] Hughes AJ,Daniel SE,Kilford L,et al. Accuracy of clinical diag-nosis of idiopathic Parkinson's disease:A clinico-pathologicalstudy of 100 cases[J]. J Neurol Neurosurg Psychiatry,1992,55(3):181-184.
[11] Katayama Y,Kasai M,Oshima H,et al. Subthalamic nucleusstimulation for Parkinson disease:Benefits observed in levodopa-intolerant patients[J]. J Neurosurg,2001,95(2):213-221.
[12] Yamamoto T,Uchiyama T,Higuchi Y,et al. Long term follow-upon quality of life and its relationship to motor and cognitive func-tions in Parkinson's disease after deep brain stimulation[J].J Neurol Sci,2017,379:18-21.
[13] Chan DT,Zhu CX,Lau CK,et al. Subthalamic nucleus deep brainstimulation for parkinson disease in hong kong:A prospective ter-ritory-wide 2-year follow-Up study[J]. World Neurosurg,2016,93:229-236.
[14] Park E,Song I,Jang DP,et al. The effect of low frequency stimu-lation of the pedunculopontine tegmental nucleus on basal gangliain a rat model of Parkinson's disease[J]. Neurosci Lett,2014,577:16-21.
[15] Cheng CH,Huang HM,Lin HL,et al. 1. 5T versus 3T MRI fortargeting subthalamic nucleus for deep brain stimulation[J]. Br JNeurosurg,2014,28(4):467-470.
[16] Aviles-Olmos I,Kefalopoulou Z,Tripoliti E,et al. Long-term outcomeof subthalamic nucleus deep brain stimulation for Parkinson'sdisease using an MRI-guided and MRI-verified approach[J].J Neurol Neurosurg Psychiatry,2014,85(12):1419-1425.
[17] Castrioto A,Lozano AM,Poon YY,et al. Ten-year outcome of subtha-lamic stimulation in Parkinson disease:A blinded evaluation[J].Arch Neurol,2011,68(12):1550-1556.
[18] Schüpbach WM,Chastan N,Welter ML,et al. Stimulation of thesubthalamic nucleus in Parkinson's disease:A 5 year follow up[J].J Neurol Neurosurg Psychiatry,2005,76(12):1640-1644.
[19] Rizzone MG,Fasano A,Daniele A,et al. Long-term outcome ofsubthalamic nucleus DBS in Parkinson's disease:From the advancedphase towards the late stage of the disease?[J]. ParkinsonismRelat Disord,2014,20(4):376-381.
[20] Krack P,Batir A,Van Blercom N,et al. Five-year follow-up ofbilateral stimulation of the subthalamic nucleus in advanced Par-kinson's disease[J]. N Engl J Med,2003,349(20):1925-1934.
[21] Devos D,Defebvre L,Bordet R. Dopaminergic and non-dopami-nergic pharmacological hypotheses for gait disorders in Parkinson's disease[J]. Fundam Clin Pharmacol,2010,24(4):407-421.
[22] Halliday G,Lees A,Stern M. Milestones in Parkinson's disease—clinical and pathologic features[J]. Mov Disord,2011,26(6):1015-1021.
[23] Jenner P. Treatment of the later stages of Parkinson's disease-pharmacological approaches now and in the future[J]. TranslNeurodegener,2015,4:3.
[24] Chan HF,Kukkle PL,Merello M,et al. Amantadine improves gaitin PD patients with STN stimulation[J]. Parkinsonism RelatDisord,2013,19(3):316-319.
[25] Weaver FM,Follett K,Stern M,et al. Bilateral deep brain stimula-tion vs best medical therapy for patients with advanced Parkinsondisease:A randomized controlled trial[J]. JAMA,2009,301(1):63-73.
[26] Deuschl G,Schade-Brittinger C,Krack P,et al. A randomized trialof deep-brain stimulation for Parkinson's disease[J]. N Engl JMed,2006,355(9):896-908.
[27] Constantinescu R,Eriksson B,Jansson Y,et al. Key clinical mile-stones 15 years and onwards after DBS-STN surgery-A retrospec-tive analysis of patients that underwent surgery between 1993 and2001[J]. Clin Neurol Neurosurg,2017,154:43-48.
[28] Jiang LL,Liu JL,Fu XL,et al. Long-term Efficacy of Subthalamicnucleus deep brain stimulation in Parkinson's disease:A 5-yearfollow-up study in China[J]. Chin Med J(Engl),2015,128(18):2433-2438.
[29] Merola A,Zibetti M,Angrisano S,et al. Parkinson's disease pro-gression at 30 years:A study of subthalamic deep brain-stimulatedpatients[J]. Brain,2011,134(Pt 7):2074-2084.
[30] Kurcova S,Bardon J,Vastik M,et al. Bilateral subthalamic deepbrain stimulation initial impact on nonmotor and motor symptomsin Parkinson's disease:An open prospective single institutionstudy[J]. Medicine(Baltimore),2018,97(5):e9750.
[31] Birchall EL,Walker HC,Cutter G,et al. The effect of unilateralsubthalamic nucleus deep brain stimulation on depression in Par-kinson's disease[J]. Brain Stimul,2017,10(3):651-656.
[32] Fasano A,Daniele A,Albanese A. Treatment of motor and non-motorfeatures of Parkinson's disease with deep brain stimulation[J].Lancet Neurol,2012,11(5):429-442.
[33] Kim HJ,Jeon BS,Paek SH. Nonmotor symptoms and subthalamicdeep brain stimulation in Parkinson's disease[J]. J Mov Disord,2015,8(2):83-91.
[34] Dafsari HS,Reddy P,Herchenbach C,et al. Beneficial effects ofbilateral subthalamic Stimulation on Non-Motor Symptoms inParkinson's disease[J]. Brain Stimul,2016,9(1):78-85.
[35] Arai E,Arai M,Uchiyama T,et al. Subthalamic deep brain stimu-lation can improve gastric emptying in Parkinson's disease[J].Brain,2012,135(Pt 5):1478-1485.
[36] Herzog J,Weiss PH,Assmus A,et al. Subthalamic stimulationmodulates cortical control of urinary bladder in Parkinso's disease[J].Brain,2006,129(Pt 12):3366-3375.
[37] Nishida N,Murakami T,Kadoh K,et al. Subthalamic nucleusdeep brain stimulation restores normal rapid eye movement sleepin Parkinson's disease[J]. Mov Disord,2011,26(13):2418-2422.
[38] Zrinzo L,Foltynie T,Limousin P,et al. Reducing hemorrhagiccomplications in functional neurosurgery:A large case series andsystematic literature review[J]. J Neurosurg,2012,116(1):84-94.
[39] Coley E,Farhadi R,Lewis S,et al. The incidence of seizuresfollowing deep brain stimulating electrode implantation for move-ment disorders,pain and psychiatric conditions[J]. Br J Neuro-surg,2009,23(2):179-183.
[40] Sorar M,Hanalioglu S,Kocer B,et al. Experience reduces surgicaland hardware-related complications of deep brain stimulationsurgery:A single-center study of 181 patients operated in Sixyears[J]. Parkinsons Dis,2018,2018:3056018.
[41] Bjerknes S,Skogseid IM,Shle T,et al. Surgical site infectionsafter deep brain stimulation surgery:Frequency,characteristicsand management in a 10-year period[J]. PLo S One,2014,9(8):e105288.
[42] Jitkritsadakul O,Bhidayasiri R,Kalia SK,et al. Systematic reviewof hardware-related complications of Deep Brain Stimulation:Donew indications pose an increased risk?[J]. Brain Stimul,2017,10(5):967-976.
[43] Pahwa R,Factor SA,Lyons KE,et al. Practice parameter:Treat-ment of Parkinson disease with motor fluctuations and dyskinesia(an evidence-based review):Report of the Quality StandardsSubcommittee of the American Academy of Neurology[J]. Neu-rology,2006,66(7):983-995.
[44] Fenoy AJ,Simpson RK Jr. Risks of common complications in deepbrain stimulation surgery:Management and avoidance[J]. J Neu-rosurg,2014,120(1):132-139.
[45] Zhang J,Wang T,Zhang CC,et al. The safety issues and hard-ware-related complications of deep brain stimulation therapy:Asingle-center retrospective analysis of 478 patients with Parkinson'sdisease[J]. Clin Interv Aging,2017,12:923-928.
[46] Obwegeser AA,Uitti RJ,Witte RJ,et al. Quantitative and qualita-tive outcome measures after thalamic deep brain stimulation totreat disabling tremors[J]. Neurosurgery,2001,48(2):274-284.
[47] Voges J,Waerzeggers Y,Maarouf M,et al. Deep-brain stimula-tion:Long-term analysis of complications caused by hardware andsurgery—experiences from a single centre[J]. J Neurol NeurosurgPsychiatry,2006,77(7):868-872.
[48] Sillay KA,Larson PS,Starr PA. Deep brain stimulator hardware-related infections:Incidence and management in a large series[J].Neurosurgery,2008,62(2):360-366.
[49] Fenoy AJ,Simpson RK Jr. Management of device-related woundcomplications in deep brain stimulation surgery[J]. J Neurosurg,2012,116(6):1324-1332.
[2] Heinrichs-Graham E,Wilson TW,Santamaria PM,et al. Neuro-magnetic evidence of abnormal movement-related beta desynchro-nization in Parkinson's disease[J]. Cereb Cortex,2014,24(10):2669-2678.
[3] AulickáSR,Jurák P,Chládek J,et al. Subthalamic nucleusinvolvement in executive functions with increased cognitive load:A subthalamic nucleus and anterior cingulate cortex depth record-ing study[J]. J Neural Transm(Vienna),2014,121(10):1287-1296.
[4] Heinrichs-Graham E,Kurz MJ,Becker KM,et al. Hypersynchronydespite pathologically reduced beta oscillations in patients withParkinson's disease:A pharmaco-magnetoencephalography study[J].J Neurophysiol,2014,112(7):1739-1747.
[5] Herrojo Ruiz M,Rusconi M,Brücke C,et al. Encoding ofsequence boundaries in the subthalamic nucleus of patients withParkinson's disease[J]. Brain,2014,137(Pt 10):2715-2730.
[6] Yin Z,Cao Y,Zheng S,et al. Persistent adverse effects followingdifferent targets and periods after bilateral deep brain stimulationin patients with Parkinson's disease[J]. J Neurol Sci,2018,393:116-127.
[7] Benabid AL,Pollak P,Gross C,et al. Acute and long-term effectsof subthalamic nucleus stimulation in Parkinson's disease[J].Stereotact Funct Neurosurg,1994,62(1/4):76-84.
[8] Buhmann C,Gerloff C. Could deep brain stimulation help withdriving for patients with Parkinson's?[J]. Expert Rev MedDevices,2014,11(5):427-429.
[9] Kim M,Cho KR,Park JH,et al. Bilateral subthalamic deep brainstimulation is an effective and safe treatment option for the olderpatients with Parkinson's disease[J]. Clin Neurol Neurosurg,2018,173:182-186.
[10] Hughes AJ,Daniel SE,Kilford L,et al. Accuracy of clinical diag-nosis of idiopathic Parkinson's disease:A clinico-pathologicalstudy of 100 cases[J]. J Neurol Neurosurg Psychiatry,1992,55(3):181-184.
[11] Katayama Y,Kasai M,Oshima H,et al. Subthalamic nucleusstimulation for Parkinson disease:Benefits observed in levodopa-intolerant patients[J]. J Neurosurg,2001,95(2):213-221.
[12] Yamamoto T,Uchiyama T,Higuchi Y,et al. Long term follow-upon quality of life and its relationship to motor and cognitive func-tions in Parkinson's disease after deep brain stimulation[J].J Neurol Sci,2017,379:18-21.
[13] Chan DT,Zhu CX,Lau CK,et al. Subthalamic nucleus deep brainstimulation for parkinson disease in hong kong:A prospective ter-ritory-wide 2-year follow-Up study[J]. World Neurosurg,2016,93:229-236.
[14] Park E,Song I,Jang DP,et al. The effect of low frequency stimu-lation of the pedunculopontine tegmental nucleus on basal gangliain a rat model of Parkinson's disease[J]. Neurosci Lett,2014,577:16-21.
[15] Cheng CH,Huang HM,Lin HL,et al. 1. 5T versus 3T MRI fortargeting subthalamic nucleus for deep brain stimulation[J]. Br JNeurosurg,2014,28(4):467-470.
[16] Aviles-Olmos I,Kefalopoulou Z,Tripoliti E,et al. Long-term outcomeof subthalamic nucleus deep brain stimulation for Parkinson'sdisease using an MRI-guided and MRI-verified approach[J].J Neurol Neurosurg Psychiatry,2014,85(12):1419-1425.
[17] Castrioto A,Lozano AM,Poon YY,et al. Ten-year outcome of subtha-lamic stimulation in Parkinson disease:A blinded evaluation[J].Arch Neurol,2011,68(12):1550-1556.
[18] Schüpbach WM,Chastan N,Welter ML,et al. Stimulation of thesubthalamic nucleus in Parkinson's disease:A 5 year follow up[J].J Neurol Neurosurg Psychiatry,2005,76(12):1640-1644.
[19] Rizzone MG,Fasano A,Daniele A,et al. Long-term outcome ofsubthalamic nucleus DBS in Parkinson's disease:From the advancedphase towards the late stage of the disease?[J]. ParkinsonismRelat Disord,2014,20(4):376-381.
[20] Krack P,Batir A,Van Blercom N,et al. Five-year follow-up ofbilateral stimulation of the subthalamic nucleus in advanced Par-kinson's disease[J]. N Engl J Med,2003,349(20):1925-1934.
[21] Devos D,Defebvre L,Bordet R. Dopaminergic and non-dopami-nergic pharmacological hypotheses for gait disorders in Parkinson's disease[J]. Fundam Clin Pharmacol,2010,24(4):407-421.
[22] Halliday G,Lees A,Stern M. Milestones in Parkinson's disease—clinical and pathologic features[J]. Mov Disord,2011,26(6):1015-1021.
[23] Jenner P. Treatment of the later stages of Parkinson's disease-pharmacological approaches now and in the future[J]. TranslNeurodegener,2015,4:3.
[24] Chan HF,Kukkle PL,Merello M,et al. Amantadine improves gaitin PD patients with STN stimulation[J]. Parkinsonism RelatDisord,2013,19(3):316-319.
[25] Weaver FM,Follett K,Stern M,et al. Bilateral deep brain stimula-tion vs best medical therapy for patients with advanced Parkinsondisease:A randomized controlled trial[J]. JAMA,2009,301(1):63-73.
[26] Deuschl G,Schade-Brittinger C,Krack P,et al. A randomized trialof deep-brain stimulation for Parkinson's disease[J]. N Engl JMed,2006,355(9):896-908.
[27] Constantinescu R,Eriksson B,Jansson Y,et al. Key clinical mile-stones 15 years and onwards after DBS-STN surgery-A retrospec-tive analysis of patients that underwent surgery between 1993 and2001[J]. Clin Neurol Neurosurg,2017,154:43-48.
[28] Jiang LL,Liu JL,Fu XL,et al. Long-term Efficacy of Subthalamicnucleus deep brain stimulation in Parkinson's disease:A 5-yearfollow-up study in China[J]. Chin Med J(Engl),2015,128(18):2433-2438.
[29] Merola A,Zibetti M,Angrisano S,et al. Parkinson's disease pro-gression at 30 years:A study of subthalamic deep brain-stimulatedpatients[J]. Brain,2011,134(Pt 7):2074-2084.
[30] Kurcova S,Bardon J,Vastik M,et al. Bilateral subthalamic deepbrain stimulation initial impact on nonmotor and motor symptomsin Parkinson's disease:An open prospective single institutionstudy[J]. Medicine(Baltimore),2018,97(5):e9750.
[31] Birchall EL,Walker HC,Cutter G,et al. The effect of unilateralsubthalamic nucleus deep brain stimulation on depression in Par-kinson's disease[J]. Brain Stimul,2017,10(3):651-656.
[32] Fasano A,Daniele A,Albanese A. Treatment of motor and non-motorfeatures of Parkinson's disease with deep brain stimulation[J].Lancet Neurol,2012,11(5):429-442.
[33] Kim HJ,Jeon BS,Paek SH. Nonmotor symptoms and subthalamicdeep brain stimulation in Parkinson's disease[J]. J Mov Disord,2015,8(2):83-91.
[34] Dafsari HS,Reddy P,Herchenbach C,et al. Beneficial effects ofbilateral subthalamic Stimulation on Non-Motor Symptoms inParkinson's disease[J]. Brain Stimul,2016,9(1):78-85.
[35] Arai E,Arai M,Uchiyama T,et al. Subthalamic deep brain stimu-lation can improve gastric emptying in Parkinson's disease[J].Brain,2012,135(Pt 5):1478-1485.
[36] Herzog J,Weiss PH,Assmus A,et al. Subthalamic stimulationmodulates cortical control of urinary bladder in Parkinso's disease[J].Brain,2006,129(Pt 12):3366-3375.
[37] Nishida N,Murakami T,Kadoh K,et al. Subthalamic nucleusdeep brain stimulation restores normal rapid eye movement sleepin Parkinson's disease[J]. Mov Disord,2011,26(13):2418-2422.
[38] Zrinzo L,Foltynie T,Limousin P,et al. Reducing hemorrhagiccomplications in functional neurosurgery:A large case series andsystematic literature review[J]. J Neurosurg,2012,116(1):84-94.
[39] Coley E,Farhadi R,Lewis S,et al. The incidence of seizuresfollowing deep brain stimulating electrode implantation for move-ment disorders,pain and psychiatric conditions[J]. Br J Neuro-surg,2009,23(2):179-183.
[40] Sorar M,Hanalioglu S,Kocer B,et al. Experience reduces surgicaland hardware-related complications of deep brain stimulationsurgery:A single-center study of 181 patients operated in Sixyears[J]. Parkinsons Dis,2018,2018:3056018.
[41] Bjerknes S,Skogseid IM,Shle T,et al. Surgical site infectionsafter deep brain stimulation surgery:Frequency,characteristicsand management in a 10-year period[J]. PLo S One,2014,9(8):e105288.
[42] Jitkritsadakul O,Bhidayasiri R,Kalia SK,et al. Systematic reviewof hardware-related complications of Deep Brain Stimulation:Donew indications pose an increased risk?[J]. Brain Stimul,2017,10(5):967-976.
[43] Pahwa R,Factor SA,Lyons KE,et al. Practice parameter:Treat-ment of Parkinson disease with motor fluctuations and dyskinesia(an evidence-based review):Report of the Quality StandardsSubcommittee of the American Academy of Neurology[J]. Neu-rology,2006,66(7):983-995.
[44] Fenoy AJ,Simpson RK Jr. Risks of common complications in deepbrain stimulation surgery:Management and avoidance[J]. J Neu-rosurg,2014,120(1):132-139.
[45] Zhang J,Wang T,Zhang CC,et al. The safety issues and hard-ware-related complications of deep brain stimulation therapy:Asingle-center retrospective analysis of 478 patients with Parkinson'sdisease[J]. Clin Interv Aging,2017,12:923-928.
[46] Obwegeser AA,Uitti RJ,Witte RJ,et al. Quantitative and qualita-tive outcome measures after thalamic deep brain stimulation totreat disabling tremors[J]. Neurosurgery,2001,48(2):274-284.
[47] Voges J,Waerzeggers Y,Maarouf M,et al. Deep-brain stimula-tion:Long-term analysis of complications caused by hardware andsurgery—experiences from a single centre[J]. J Neurol NeurosurgPsychiatry,2006,77(7):868-872.
[48] Sillay KA,Larson PS,Starr PA. Deep brain stimulator hardware-related infections:Incidence and management in a large series[J].Neurosurgery,2008,62(2):360-366.
[49] Fenoy AJ,Simpson RK Jr. Management of device-related woundcomplications in deep brain stimulation surgery[J]. J Neurosurg,2012,116(6):1324-1332.