课件：帕金森病进修.ppt

* * 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 Activa? 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 * * * * * * * * * STN-DBS术后异动平均减少69.1% (95% CI:62.0%–76.2%) 觉醒期无异动开期提高27% 到74% 无异动症开期 关期 开期伴异动症 术前 (n=96) 49% 27% 23% STN-DBS术后6M (n=91) 74%* 19% 7% DBS疗效模式图 Dyskinesia “On” Time “Off” Time This graph is only for illustrative purposes and does not represent actual “on” and “off” time. Before After STN-DBS术后左旋多巴等效剂量平均减少55.9% (95% CI: 50%–61.8%) STN DBS对运动障碍疗效限度：术后UPDRS III 评分改变不超过术前左旋多巴试验 运动症状的改善维持5年以上 OFF-Medication Motor Score Improvements* 6-month 1-year 3 years 5 years Tremor 79% 75% 83% 75% Rigidity 58% 73% 74% 71% Akinesia 42% 63% 52% 49% *Results for STN DBS与损毁术的比较 DBS的优越性 符合生理要求，疗效持续。 损伤较小，副作用少。 不影响其他治疗方法起效，有协同作用。 术后刺激器可以调整。 STN-DBS的并发症 DBS疗效影响因素分析 DBS疗效的最佳预测因素：左旋多巴反应性 左旋多巴反应性是STN-DBS疗效的重要预测因素。 左旋多巴challenge test可预测STN-DBS UPDRS改善程度。 左旋多巴可改善步态和姿势稳定性的患者STN-DBS的疗效也好。 年龄 年龄并未确定成为手术疗效的重要预测因素。 老年患者中STN-DBS的风险/效益比高。 认知功能障碍等年龄相关疾病，