Therapeutic Evaluation And Follow-up Analysis Of Deep Brain Stimulation In The Treatment Of Primary Parkinson's Disease

BackgroundParkinson's disease(PD)is also known as tremor palsy.The annual incidence rate is about 16-19/10 million in the world,which is next to Alzheimer's disease.The incidence of the disease increases with age.The clinical symptoms were characterized by motor symptoms such as static tremor,motor delay,muscle rigidity and postural disturbance and by non motor symptoms such as neuropsychiatric symptoms,autonomic nervous dysfunction,and olfactory disorder.PD in middle and late stage affects the quality of life of patients seriously,and brings many problems to patients and their families.With the development of functional department of Neurosurgery,deep brain stimulation(DBS)has been known by more and more people,and has become a new choice for the treatment of PD.With the aid of stereotactic technology,DBS can accurately implant the electrodes into the corresponding nucleus in the operation,and produce the stimulation effect.At the same time,it is widely used in clinical practice with its adjustable advantages.The pulse stimulator controls the voltage,frequency,pulse width and other parameters of the electrode to control the motion symptoms,so as to change the excitability of the related nucleus and correct the abnormal loop,which is used to treat the neuromental diseases and relieve the symptoms of the nervous system.It is a relatively safe,reversible and adjustable neural regulation method.It is a potential neuromodulation therapy.ObjectiveThe two targets of the pallidus medialis(Gpi)and the subthalamic nucleus(STN)were evaluated for the therapeutic effect of DBS on PD.To compare the efficacy of Gpi DBS and STN DBS in the treatment of PD.MethodsThe clinical data of PD patients who received GPI(n=8)or STN(n=13)DBS operation in the First Affiliated Hospital of Zhengzhou University from July 2016 to October 2017 were retrospectively analyzed.Using the Unified Parkinson's disease rating scale(UPDRS(MDS))and Beck Depression inventory(BDI)to evaluate the symptoms,mental symptoms and quality of life of the patients with PD.The scores of motor symptoms and non motor symptoms in PD patients were statistically analyzed.ResultsMotor symptoms: according to the UPDRS scale(UPDRS?-?),the movement symptoms of the two groups were obviously improved(Gpi DBS group P=0.001;STN DBS group P=0.000),and the two groups had no significant difference in the effect of motor symptoms(P=0.242).Non motor symptoms: According to the BDI scale,the depressive symptoms in group Gpi DBS were improved(P=0.003),and the improvement of depressive symptoms in group STN DBS was not statistically significant(P=0.357).According to the UPDRS scale(UPDRS?),the non motor symptoms in the Gpi DBS group were improved(P=0.014),and the improvement of non motor symptoms in the STN DBS group was not statistically significant(P=0.874).The dosage of levodopa: the dosage of levodopa in the two groups had a certain degree of reduction(Gpi DBS group P=0.009;STN DBS group P=0.000),while the curative effect of Gpi DBS group and STN DBS group was different(P=0.000),and the decrease of levodopa after the STN group was more significant.Follow up: according to UPDRS scale(UPDRS?-?),2 weeks,3 months and 6 months after operation.With the prolongation of DBS implantation time,the improvement of motor symptoms is more significant.Gpi DBS group: the curative effect of 3 months after operation is better than that of 2 weeks after operation(P=0.018),and the curative effect of 6 months after operation is better than that of 3 months after operation(P=0.030).STN DBS group: the curative effect of 3 months after operation is better than that of 2 weeks after operation(P=0.001),and the curative effect of 6 months after operation is better than that of 3 months after operation(P=0.005).Conclusions1.For the improvement of motor symptoms,Gpi DBS and STN DBS have significant effect,but the difference between the two is not significant.2.For the improvement of non motor symptoms,the effect of Gpi DBS is better than that of STN DBS.3.For postoperative reduction of levodopa dosage,the effect of STN DBS is more significant.4.The longer the implantation time of DBS electrode,the more significant the improvement of motor symptoms.