Clinical Analysis Of Subthalamic Nucleus Stimulation In The Treatment Of PD

Objective: to investigate the clinical effect of subthalamic electric stimulation(STN-DBS)in patients with Parkinson’s disease(PD).Methods: retrospective in July2003 to December 2017 in the xinjiang military region general hospital to accept the STN-DBS treatment data of 84 patients with PD,(1)analysis of 84 cases of PD patients with postoperative complications,and preoperative and postoperative march "on" and "off" unified Parkinson’s movement under two kinds of state scale(UPDRSIII),daily life ability scale(ADL)score,and the change of the oral dose levodopa;(2)to observe the incidence of postoperative complications in 28 cases after the introduction of "standardized system management"(SOP)and 56 cases before conventional surgery,and to compare the changes of UPDRSIII and ADL scores 1 year after surgery between the two groups;(3)The changes of UPDRSIII and ADL scores before and after surgery in 54 han and 17 uygur populations were analyzed,and the improvement of tremor and rigidity symptoms in 17 uygur populations before and after surgery were compared.(4)of course of disease >5 years group of 69 cases and course of disease <5 years group of 15 PD patients before and after surgery of the changes in UPDRSIII and ADL scores;(5)It shall observe the changes of UPDRSIII,ADL,simple intelligent scale(MMSE),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),and Pittsburgh sleep quality index scale(PSQI)scores of 6 PD patients over 75 years before and 1 year after the operation.Results:(1)none of the 84 patients with PD presented permanent severe surgical complications,1patient was found to have obvious dysarsaras,and 4 patients presented chronic rupture of electrodes and stimulators.Debridement suture and/or position adjustment were given and recovered.Two patients presented severe puncture tract edema,and the symptoms disappeared 2 months later.One case presented status epilepticus after electrode implantation.Three months after surgery,the improvement rate of UPDRSIII score in the "open" stage was 41.8%,that in the "close" stage was 51.6%,and the levodopa dose was55.6% lower than that before surgery.(2)The "SOP" management group and the conventional surgery group,1 year after surgery compared with the preoperative UPDRSIII and ADL scores were significantly improved(p<0.05),and there was no significant difference between the groups(p>0.05),but,7 cases of postoperative complications occurred in the conventional surgery group,including 3 cases of surgical-related complications,while the "SOP" management group only 1 case of complications,no surgical-related complications.(3)The postoperative UPDRSIII and ADL scores of 54 han and 17 uygur patients were significantly improved compared with those before surgery(p<0.05),and there was no significant difference between the two groups(p>0.05).(4)duration > 5 years of high course group and the course of < 5 years of low course of postoperative compared with preoperative UPDRSIII and ADL scores were significantly lower(p<0.05),postoperative UPDRSⅢ grading period 1 year,respectively(60.4%,63.1%);ADL grading period(43.8%,57.9%),respectively,after 1 year UPDRSⅢ score between the two groups had no significant difference(p>0.05),lower course of ADL score is better than that of high course group(p<0.05);(5)6 patients older than 75 1year postoperatively in patients with PD UPDRSⅢ "off" state and the symptom scores compared with preoperative were significantly decreased(p<0.05),and the movement score of ADL,HAMD,PSQI more preoperative also significantly reduced(p<0.05),at the same time,MMSE,HAMA scores compared with preoperative increased(p>0.05);Conclusion: STN-DBS treatment for PD can significantly improve patients’ exercise symptoms,reduce the dosage of drugs,and no serious surgical complications.Therefore,stn-dbs is a safe and reliable treatment.For PD patients over 75 years old,STN-DBS can not only significantly improve PD patients’ motor symptoms,but also improve non-motor symptoms,and improve the quality of life of patients.STN-DBS is also effective for PD patients of han nationality and uygur nationality.The improvement of ADL in PD patients with disease course <5 years with STN-DBS was more obvious than that in patients with disease course >5 years.The introduction of "SOP" into stn-dbs surgery can effectively reduce the occurrence of surgical complications.However,long-term follow-up is still needed to evaluate the efficacy of PD patients.