摘要目的 探讨丘脑底核脑深部电刺激术(STN-DBS)在帕金森病(PD)撤药恶性综合征(NMS)治疗中的作用. 方法 回顾性分析新疆军区总医院神经外科2014年12月、2018年11月收治的2例NMS患者病史、症状特点,以及STN-DBS程控治疗过程及预后. 结果 2例患者发病前均有STN-DBS手术史,以及抗PD药物“减量”事件.入院时均表现为意识障碍、高热、原有症状的加重,以及肌酸磷酸激酶的增高,且上诉症状与感染转归不相关.入院后均给予补充抗PD药物及支持性治疗,同时多次调整STN-DBS刺激参数改善症状,其中例1最终参数调整为左侧(C+,2-、1-),脉宽110 μs,频率200 Hz,强度3.8V;右侧(C+,6-、5-),脉宽110 μs,频率200 Hz,强度4.4 V;例2最终参数调整为左侧(C+,3-),脉宽60μs,频率130 Hz,强度2.0 V;右侧(C+,6-),脉宽80μs,频率160Hz,强度2.8V.2例患者均治愈出院,但随访6个月时患者仍存在运动功能障碍,生活自理能力严重受损. 结论 STN-DBS在NMS治疗中可能起到重要的协同作用.

abstractsObjective To explore the role of deep brain stimulation of subthalamic nucleus (STN-DBS) in treatment of Parkinson's disease (PD) related neuroleptic malignant syndrome (NMS).Methods The medical history,clinical features,STN-DBS programmed treatment process and treatment results of two patients admitted to our hospital in December 2014 and November 2018 were retrospectively analyzed.Results Two patients with post-operative STN-DBS were evoked by dose-reduced treatment of anti-parkinsonian drugs,and presented with high fever,disorder of consciousness,aggravation of the original parkinsonism,and increase of creatine phosphokinase,which were not correlated with outcomes of infection.After admission,anti-parkinsonian drugs and other supportive therapies were supplemented;STN-DBS modulation were given to improve the symptoms;the final parameters of patient one were the left (C+,2-,1-),pulse width 110 μs,frequency 200 Hz,and strength 3.8 V;the right side (C+,6-,5-),pulse width 110 μs,frequency 200 Hz,strength 4.4 V;and those of patient two were the left (C+,3-),pulse width 60 μs,frequency 130 Hz,strength 2.0 V;right side (C+,6-),pulse width 80 μs,frequency 160 Hz,and strength 2.8 V.Both patients were cured,but their motor function and self-care ability were severely impaired.Conclusion STN-DBS may play an important role in the treatment of PD related NMS.