刺激参数优化对帕金森病双侧STN-DBS术后电刺激诱发的暂时性非运动精神症状的改善效果

摘要

目的:探讨帕金森病双侧丘脑底核脑深部电刺激(STN-DBS)术后,在出现电刺激诱发的暂时性非运动精神症状(stimulation-induced transient nonmotor psychiatric symptoms,SITNPS)时,是否可通过流程图来确定诱发症状的触点,以及电刺激参数优化在去除精神症状的同时维持运动症状改善的最佳效果.方法:回顾性分析了2015年1月1日至12月31日在长海医院神经调控门诊进行程控的帕金森病STN-DBS患者的程控资料.分析使用流程图确定SITNPS触点及程控调整方案的效果,并采用非盲法的统一帕金森病评估量表Ⅲ(unified Parkinson's disease rating scale-Ⅲ,UPDRS-Ⅲ)评估患者运动功能的改变.结果:共有1 287人次程控.11例患者出现了20次SITNPS,包括4次哭泣(2例)、4次莫名的欣快感或傻笑(2例)、2次空间定位感觉异常(1例)、2次幻觉(1例)及8次轻躁狂发作(5例).通过优化程控参数,10例患者精神症状消失,且运动改善维持或好于发生SITNPS时;1例患者在多次程控后由于运动症状和非运动症状交替出现,在最后设定的刺激参数下,UPDRS-Ⅲ评分较前下降了2分.11例患者的UPDRDⅢ评分在程控前后(Med off/IPG on)差异无统计学意义[(26.45±10.59)分vs(26.45±10.17)分,P=1.000].结论:本课题组设计的流程图有助于确定SITNPS诱发触点;程控参数优化可使患者SITNPS消失,且不影响运动功能的改善效果.%Objective:Stimulation-induced transient non-motor psychiatric symptom (SITNPS) was one of the side effects following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson disease (PD) patients.The electrode contact inducing these psychiatric symptoms and the protocol to eliminate SITNPS with maintaining the optimal motor function were designed in this study,and the effectiveness of these algorithms was analyzed.Methods:All the PD patients who underwent programming sessions after STN-DBS implantations from January 1,2015,to December 31,2015,at the DBS programming clinic of Changhai Hospital were retrospectively analyzed.Only patients who were diagnosed with SITNPS were enrolled in this study.In these patients,the electrode contact inducing SITNPS was found and the programming protocol algorithms were used.The unified Parkinson disease rating scale part Ⅲ (UPDRS-Ⅲ) score was assessed with non-blinded method to analyze the motor functions before and after programming.Results:There were 1 287 patients-time enrolled in this study,and 11 patients were diagnosed with SITNPS of totally 20 times.Among these patients,2 cases had 4 episodes of crying,2 cases had 4 episodes of mirthful laughter,1 case had 2 episodes of abnormal sense of spatial orientation,1 case had 2 episodes of hallucination and 5 cases had 8 episodes of hypomania.After programming sessions,the mental symptoms in 10 patients were disappeared and the motor functions were maintained or better compared with SITNPS.In 1 patient,the motor and non-motor symptoms occurred alternately,at last,the UPDRS-Ⅲ score was decreased by 2 scores after stimulus parameter setting.There was no statistical difference of UPDRS-Ⅲ score before and after final stimulation parameter setting (without SITNPS) in 11 cases ([26.45±10.59] vs [26.45±10.17],P=l.000).Conclusions:The flow diagram in this study is helpful for determining electrode contact inducing SITNPS in PD patients,and the modified programming protocol employed in treatment of these symptoms is effective to make SITNPS disappear,without influencing the curative effect on motor function.