丘脑底核变频电刺激治疗帕金森病冻结步态的研究
The effect of variable frequency stimulation of subthalamic nucleus on freezing gait of patients with Parkinson's disease
目的 初步探讨丘脑底核(STN)变频电刺激治疗伴有冻结步态帕金森病(PD)患者的疗效.方法 回顾性纳入首都医科大学附属北京天坛医院神经外科2016年5月至2017年7月经STN-高频电刺激治疗后冻结步态未缓解的7例PD患者,均行STN-变频电刺激治疗.治疗后对所有患者行门诊随访,通过检测统一PD评分量表第Ⅲ部分(UPDRS-Ⅲ)和冻结步态问卷(FOGQ)评估其运动和步态功能改善情况.结果 变频电刺激1周,PD患者UPDRS-Ⅲ评分较基线显著降低[分别为(23.3±8.1)分、(45.3±7.2)分,P <0.05],但与高频电刺激时的差异无统计学意义[(31.0±10.0)分,P>0.05];FOGQ评分较基线显著降低[分别为(11.7±6.1)分、(17.3±5.1)分,P<0.05],冻结步态改善率较高频电刺激治疗时显著提高[分别为(45.6±22.7)%、(13.8±10.9)%,P<0.05].7例患者的随访时间为3~ 12个月,平均(7.3±4.0)个月.UPDRS-Ⅲ评分为(19.9±7.0)分,运动功能的改善率为(56.2±15.8)%,较高频电刺激治疗显著改善(P<0.05),但与变频电刺激治疗1周比较,差异无统计学意义(P >0.05);FOGQ评分为(11.0±5.7)分,冻结步态改善率为(48.0±19.4)%,较高频电刺激治疗时显著增高(P<0.05),但与变频电刺激1周的差异无统计学意义(P>0.05).结论 STN-变频电刺激对于缓解PD患者的冻结步态较高频电刺激的疗效满意且稳定.
更多Objective To explore the treatment efficacy of variable frequency stimulation (VFS) of subthalamic nucleus (STN) on freezing of gait (FOG) in patients with Parkinson's disease (PD).Methods Seven patients with PD were treated by VFS from May 2016 to July 2017 at Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University.Those patients had failed to improve their FOG with STN stimulation with high frequency stimulation (HFS).All patients were followed up at the outpatient clinic following VFS-STN stimulation.The third part of Unified Parkinson's Disease Rating Scale (UPDRS-Ⅲ) and Freezing of Gait Questionnaire (FOGQ) were employed to explore the treatment efficacy on the patient's motor and gait improvement.Results In the early stage of VFS,the UPDRS-Ⅲ score was significantly lower than that in baseline (23.3 ±8.1 vs.45.3 ± 7.2,P < O.05),while there was no significant difference for HFS (31.0 ± 10.0 vs,P >0.05).The FOGQ score was significantly lower than that in baseline(11.7 ± 6.1 vs.17.3 ±5.1,P < 0.05).The improvement rate of FOGQ was significantly higher for VHS than that for HFS [(45.6 ±22.7)% vs.(13.8 ±10.9)%,P <0.05].The follow-up time was 3-12 months (mean,7.3 ±4.0 months).At this time,the UPDRS-Ⅲ score was (19.9 ±7.0) and the improvement rate was (56.2 ± 15.8)%,which was significantly higher than that for HFS (P < 0.05) but was not significantly different from that in the early stage.The FOGQ score was (11.0 ±5.7).The improvement rate of FOGQ was (48.0 ±19.4)%,which was significantly higher than that in HFS (P <0.05) but was not significantly different from that in the early stage.Conclusion For relief of FOG in patients with PD,the effect of VFS could be more remarkable and stable.
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