治疗仪脑深部刺激治疗ppt课件.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 * * * * * * * * * * * * * * 特发性震颤的Activa治疗 69% 的特发性震颤病人，在接受Activa治疗后，得到了全部或者绝大多数的症状控制 * 显著减少了患者致残的几率。 刺激可能诱发一些副作用，短暂的感觉异常, 构音障碍, 平衡障碍 绝大多数副作用是暂时的并可以通过调整刺激参数加以消除或减弱 * Data on File. Medtronic, Inc. 特发性震颤的治疗指南 美国神经科学会 (AAN) 在2005年6月发布的特发性震颤治疗指南中指出 单侧DBS 治疗对四肢可以达到显著减少 (60 to 90%)。 Zesiewicz TA, Elbe R, Louis ED, et al. Practice Parameter: Therapies for essential tremor. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2005;64:2008-2020 Activa治疗：肌张力障碍 肌张力障碍的DBS治疗 肌张力障碍 持续的肌肉收缩, 导致身体某一部位频繁的扭动和重复运动, 或者姿势异常 发病情况: 平均年龄 = 27, 一般9岁或者40岁为两发病高峰 异动的症状可能会随身体的运动而增加 肌张力障碍的药物治疗 抗胆碱能药物 多巴胺能药物 安定类药物 巴氯芬 局部肉毒素注射 肌张力障碍的Activa治疗 目前已经得到FDA的HDE许可 Humanitarian Device Exemption (HDE) *Humanitarian Device Exemption approval for patients 7 years and older DBS主要参考文献 帕金森病 The Deep-Brain Stimulation for Parkinson’s Dis