帕金森病患者经脑深部电刺激治疗后非运动症状临床综合调查分析
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摘要
目的
分别对正在接受深部脑刺激(Deep brain stimulation, DBS)治疗的帕金森病(Parkinson’s disease,PD)患者与接受单纯药物治疗的PD患者进行非运动症状综合评估和对照分析,探讨DBS治疗对PD患者非运动症状的影响。
方法
随机选取25例正在接受DBS治疗的PD患者(DBS组)及25例接受单纯药物治疗的PD患者(药物组),分别进行问卷式调查。运动功能的测验工具是统一帕金森病评定量表Ⅲ部分(UPDRSⅢ);非运动症状测验工具包括简易精神状态量表(MMSE)、修订的阿尔茨海默病评定量表-认知(ADAS-cog)、汉密尔顿(HAMD)和抑郁量表(CES-D)以及PSQI匹兹堡睡眠质量指数、NF疲劳量表,便秘量表分别对认知功能、抑郁、睡眠障碍、疲劳和便秘进行评价。
结果
与单纯服用抗帕金森药物的PD患者相比,接受双侧丘脑底核(Subthalamic Nucleus, STN)DBS治疗的PD患者在UPDRSⅢ有明显改善(P<0.001);HAMD、CES-D量表结果显示接受DBS治疗的PD患者抑郁程度和发生频度亦有明显改善(P<0.05);PSQI、NF量表评分也有显著改善(P<0.05);MMSE、ADAS-cog与便秘量表DBS组与药物组评分无明显差异。相关性分析显示运动功能的改善能显著影响抑郁程度(r=0.725)和发生频度(r=0.651)(P<0.05)。
结论
DBS术能显著改善PD患者的运动功能,进一步影响抑郁、睡眠功能,从而改善非运动症状。
Obective
To respectively evaluate and contrast analysis the non-motor symtoms of patients with Parkinson’s Disease (PD) undergoing deep brain stimulation(DBS)therapy and simple drug treament, observe the motor function and non-motor symtoms improvement of DBS therapy on PDpatients.
Methods
Twenty-five patients with PD were included in a paired design study. The patients were randomly divided into DBS and anti- Parkinson’s medication control groups , surveied by a questionnaire-type. Motor fluctuation and dyskinesia assessment was by the Unified Parkinson Disease Rating Scale PartⅢ; non-motor symtoms assessment included the Mini Mental State Examination (MMSE), Alzheimer’s Disease Rating Scale Revised-Cognitive (ADAS-cog), Hamilton (HAMD) and the Center for Epidemiologic Studies Depression Scale (CES-D); Pittsburgh sleep quality index ( PSQI ), Fatigue Scale (NF) and Constipation Scale.
Results
Compared with the medication control group, significant benefit was obtained in motor manifestations(UPDRS section3, P<0.001) of the DBS group, and its PSQI, NF HAMD and CES-D (P<0.05), without MMSE、ADAS-cog and Constipation Scale .Correlation analysis showed that Motor function could impact the extent and frequency of depression. Conclusions In the accordance with our results, DBS significantly improved the motor function and depression, the quality of sleep important aspects with advanced PD.
分别对正在接受深部脑刺激(Deep brain stimulation, DBS)治疗的帕金森病(Parkinson’s disease,PD)患者与接受单纯药物治疗的PD患者进行非运动症状综合评估和对照分析,探讨DBS治疗对PD患者非运动症状的影响。
方法
随机选取25例正在接受DBS治疗的PD患者(DBS组)及25例接受单纯药物治疗的PD患者(药物组),分别进行问卷式调查。运动功能的测验工具是统一帕金森病评定量表Ⅲ部分(UPDRSⅢ);非运动症状测验工具包括简易精神状态量表(MMSE)、修订的阿尔茨海默病评定量表-认知(ADAS-cog)、汉密尔顿(HAMD)和抑郁量表(CES-D)以及PSQI匹兹堡睡眠质量指数、NF疲劳量表,便秘量表分别对认知功能、抑郁、睡眠障碍、疲劳和便秘进行评价。
结果
与单纯服用抗帕金森药物的PD患者相比,接受双侧丘脑底核(Subthalamic Nucleus, STN)DBS治疗的PD患者在UPDRSⅢ有明显改善(P<0.001);HAMD、CES-D量表结果显示接受DBS治疗的PD患者抑郁程度和发生频度亦有明显改善(P<0.05);PSQI、NF量表评分也有显著改善(P<0.05);MMSE、ADAS-cog与便秘量表DBS组与药物组评分无明显差异。相关性分析显示运动功能的改善能显著影响抑郁程度(r=0.725)和发生频度(r=0.651)(P<0.05)。
结论
DBS术能显著改善PD患者的运动功能,进一步影响抑郁、睡眠功能,从而改善非运动症状。
Obective
To respectively evaluate and contrast analysis the non-motor symtoms of patients with Parkinson’s Disease (PD) undergoing deep brain stimulation(DBS)therapy and simple drug treament, observe the motor function and non-motor symtoms improvement of DBS therapy on PDpatients.
Methods
Twenty-five patients with PD were included in a paired design study. The patients were randomly divided into DBS and anti- Parkinson’s medication control groups , surveied by a questionnaire-type. Motor fluctuation and dyskinesia assessment was by the Unified Parkinson Disease Rating Scale PartⅢ; non-motor symtoms assessment included the Mini Mental State Examination (MMSE), Alzheimer’s Disease Rating Scale Revised-Cognitive (ADAS-cog), Hamilton (HAMD) and the Center for Epidemiologic Studies Depression Scale (CES-D); Pittsburgh sleep quality index ( PSQI ), Fatigue Scale (NF) and Constipation Scale.
Results
Compared with the medication control group, significant benefit was obtained in motor manifestations(UPDRS section3, P<0.001) of the DBS group, and its PSQI, NF HAMD and CES-D (P<0.05), without MMSE、ADAS-cog and Constipation Scale .Correlation analysis showed that Motor function could impact the extent and frequency of depression. Conclusions In the accordance with our results, DBS significantly improved the motor function and depression, the quality of sleep important aspects with advanced PD.
引文
1. Zhang ZX,Roman GC,Hong Z,et al.Parkinson's disease in China:prevalence in Beijing,Xi'an,and Shanghai.Lancet,2005,365:595-597.
2. Chaudhuri KR, Healy DG, Schap A. Lancet Neurol, 2006,5:235.
3. Blum D, Torch S, Lambeng N, et al.Molecular pathways involved in the neurotoxicity of 6-OHDA, dopamine and MPTP:contribution to the apoptotic theory in Parkinson' s disease [J]. Prog Neurobiol,2001,65(2): 135.
4. Rouse ST,Marino MJ,Bradley SR,Awad H,Wittmann M,Conn PJ. Distribution and roles of metabotropic glutamate receptors in the basal ganglia motor circuit: implications for treatment of Parkinson's disease and related disorders. Pharmacol Ther 2000;88(3):427-435.
5. Benabid AL.Long_term suppression of tremor by chronic stimula tion of the ventral intermediate thalamic nucleus[J].Lancet, 1991,337:403
6. Bechereva NP.Method of eletrostimulation of the deep brain structure in treatment some chronic disease[J].Confin Neurol, 1975,37:136
7. Brice J.Supprosion of intention tremor by contingent deep_brain stimulation [J].Lancet,1980,1:1 221
8. Ohye C,Hirai T,Miyazaki M,et al.VIM thalamotomy for the treatment varionskinds tremor[J].Applied.Neurophysiology, 1982,45:275
9. Hirain T,Miyazaki M,Nakajma H,et al.The correlation between tremor characteristics and predicted volume of effective lesions in stereotaxic nu cleusventralisintermedius thalamotomy[J].Brain,1983,106:1 201
10. Andy OJ.Thalamic stimulation for control of movement disordersby chronic tereotaxic stimulation of the ventral intermediate thalamic nucleus[J].JNeurosurg, 1992,77:62 11.
11. Limousine P,Pollak P,Benazzouz A,et al.Improvement in parkinsonian symptoms after bilateral subthalamic nucleus stimulation[J].Lancet,1995,345:91 12.
12. Tronnier VM,Fogel W,Kronenbuercer M,et al.Pallidal stimulation:an al ternative to pallidotomy[J].J Neurosurg,1997,87:700 13.
13. Ghika J,Villermuer J,Fankhauser H,et al.Effeciency and safety of bilateral contemporaneous pallidal stimulation(deep brain stimulation) in levodopare sponsive patients with Parkinson’s disease with severe motor fluctuations:a 2-years follow- up review[J].J Neurosurg,1998,89:713
1.肖海兵,蒋丽丽,曹旭,等.帕金森病患者轻度认知损害的临床调查[ J ].中华神经科杂志,2008,41(8): 520.
2.郑瑾,乔娴,孙圣刚.帕金森患者亚抑郁的研究[ J ].卒中与神经疾病杂志,2010, (1)
3. Kuopio AM,Marttila RJ,Helenius H,et a1. The quality 0f life in Parkinson’s disease. M0v Disord,2000,15(2):216.
4.张世忠,徐强,徐如祥,等.脑深部刺激电极埋置术治疗帕金森病疗效研究[ J ].中国神经精神疾病杂志, 2003, 29 ( 6 ) : 404.
5. Lewinsohn PM, Seeley JR, Roberts RE, et al. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging, 1997, 12: 277-287.
6.王学廉,常崇旺,耿宁,等.双侧丘脑底核电刺激对帕金森病患者抑郁状况的影响[ J ],中国神经精神疾病杂志, 2009,35 (2): 88
7. Kumlar R, Lozano AM, Kim YJ, et al. Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinon’s disease . Neurology, 1998, 51(3):850 .
8. Troster AI, Fields JA, Wilkinison S, et al. Effect of motor improvement on quality of life following subthalamic stimulation is mediated by changes in depressive symptomatology. Stereotact Funct Neurosurg, 2003, 80(1-4):43.
9. Kaiser I, Kryspin-Exner I, Brücke T, et al. Long-term effects of STN DBS on mood: psychosocial profiles remain stable in a 3-year follow-up. BMC Neurology, 2008, 8:43
10.Alim LB. Deep brain stimulation for Parkinson’s disease. Current Opinion in Neurobiology 2003, 13:696-706.
11.WALTER B L, V ITEK J L. Surgical treatment for : Parkins on’s disease[ J ]. Lancet Neurl, 2004, 3: 719 - 728.
12.F IGUEI RASMENDEZ R, REGI DOR I , R I VA MEANA C, et al . Further supporting evidence of beneficial subthalamic stimulation in Parkins on’s patients[ J ]. Neur ology, 2002, 58: 469 - 470.
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2. Chaudhuri KR, Healy DG, Schap A. Lancet Neurol, 2006,5:235.
3. Blum D, Torch S, Lambeng N, et al.Molecular pathways involved in the neurotoxicity of 6-OHDA, dopamine and MPTP:contribution to the apoptotic theory in Parkinson' s disease [J]. Prog Neurobiol,2001,65(2): 135.
4. Rouse ST,Marino MJ,Bradley SR,Awad H,Wittmann M,Conn PJ. Distribution and roles of metabotropic glutamate receptors in the basal ganglia motor circuit: implications for treatment of Parkinson's disease and related disorders. Pharmacol Ther 2000;88(3):427-435.
5. Benabid AL.Long_term suppression of tremor by chronic stimula tion of the ventral intermediate thalamic nucleus[J].Lancet, 1991,337:403
6. Bechereva NP.Method of eletrostimulation of the deep brain structure in treatment some chronic disease[J].Confin Neurol, 1975,37:136
7. Brice J.Supprosion of intention tremor by contingent deep_brain stimulation [J].Lancet,1980,1:1 221
8. Ohye C,Hirai T,Miyazaki M,et al.VIM thalamotomy for the treatment varionskinds tremor[J].Applied.Neurophysiology, 1982,45:275
9. Hirain T,Miyazaki M,Nakajma H,et al.The correlation between tremor characteristics and predicted volume of effective lesions in stereotaxic nu cleusventralisintermedius thalamotomy[J].Brain,1983,106:1 201
10. Andy OJ.Thalamic stimulation for control of movement disordersby chronic tereotaxic stimulation of the ventral intermediate thalamic nucleus[J].JNeurosurg, 1992,77:62 11.
11. Limousine P,Pollak P,Benazzouz A,et al.Improvement in parkinsonian symptoms after bilateral subthalamic nucleus stimulation[J].Lancet,1995,345:91 12.
12. Tronnier VM,Fogel W,Kronenbuercer M,et al.Pallidal stimulation:an al ternative to pallidotomy[J].J Neurosurg,1997,87:700 13.
13. Ghika J,Villermuer J,Fankhauser H,et al.Effeciency and safety of bilateral contemporaneous pallidal stimulation(deep brain stimulation) in levodopare sponsive patients with Parkinson’s disease with severe motor fluctuations:a 2-years follow- up review[J].J Neurosurg,1998,89:713
1.肖海兵,蒋丽丽,曹旭,等.帕金森病患者轻度认知损害的临床调查[ J ].中华神经科杂志,2008,41(8): 520.
2.郑瑾,乔娴,孙圣刚.帕金森患者亚抑郁的研究[ J ].卒中与神经疾病杂志,2010, (1)
3. Kuopio AM,Marttila RJ,Helenius H,et a1. The quality 0f life in Parkinson’s disease. M0v Disord,2000,15(2):216.
4.张世忠,徐强,徐如祥,等.脑深部刺激电极埋置术治疗帕金森病疗效研究[ J ].中国神经精神疾病杂志, 2003, 29 ( 6 ) : 404.
5. Lewinsohn PM, Seeley JR, Roberts RE, et al. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging, 1997, 12: 277-287.
6.王学廉,常崇旺,耿宁,等.双侧丘脑底核电刺激对帕金森病患者抑郁状况的影响[ J ],中国神经精神疾病杂志, 2009,35 (2): 88
7. Kumlar R, Lozano AM, Kim YJ, et al. Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinon’s disease . Neurology, 1998, 51(3):850 .
8. Troster AI, Fields JA, Wilkinison S, et al. Effect of motor improvement on quality of life following subthalamic stimulation is mediated by changes in depressive symptomatology. Stereotact Funct Neurosurg, 2003, 80(1-4):43.
9. Kaiser I, Kryspin-Exner I, Brücke T, et al. Long-term effects of STN DBS on mood: psychosocial profiles remain stable in a 3-year follow-up. BMC Neurology, 2008, 8:43
10.Alim LB. Deep brain stimulation for Parkinson’s disease. Current Opinion in Neurobiology 2003, 13:696-706.
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