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1、深部腦電刺激治療帕金森病的FDGPET研究管一暉1左傳濤1李殿友2孫伯民3趙軍1華逢春1林祥通11.復(fù)旦大學(xué)附屬華山醫(yī)院PET中心2000402.吉林大學(xué)第一醫(yī)院神經(jīng)外科3.復(fù)旦大學(xué)附屬華山醫(yī)院功能神經(jīng)外科[摘要]目的:研究雙側(cè)丘腦底核(STN)慢性電刺激術(shù)(DBS)對(duì)晚期帕金森?。≒D)患者腦局部糖代謝的影響,并探討DBS的作用機(jī)制。方法:對(duì)7例進(jìn)行雙側(cè)STNDBS的晚期帕金森病患者,在術(shù)前和術(shù)后1個(gè)月電刺激條件下,分別進(jìn)行18F-脫氧葡萄糖(18F-FDG)PET顯像和UPDRS評(píng)分,并通過(guò)SPM數(shù)據(jù)分析,研究雙側(cè)STNDBS對(duì)PD患者腦代謝的影響。結(jié)果:雙側(cè)STNDBS使7例P
2、D患者臨床癥狀明顯改善,同時(shí)腦局部糖代謝也發(fā)生了明顯變化,雙側(cè)豆?fàn)詈?,腦干(中腦、腦橋)、雙側(cè)頂枕部、運(yùn)動(dòng)前區(qū)(BA6)及扣帶回的腦代謝增加;前額葉底部、海馬的腦代謝減少(P<0.05)。結(jié)論:雙側(cè)STNDBS可能通過(guò)興奮STN軸突的方式,使軸突投射區(qū)域的基底節(jié)上行和下行通路代謝改善,并增加相應(yīng)的額葉高級(jí)運(yùn)動(dòng)中樞的代謝,使PD患者臨床癥狀改善。FDGPET可能是為STN治療挑選合適病例的方法之一.關(guān)鍵詞帕金森病PET脫氧葡萄糖丘腦底核腦深部電刺激中國(guó)圖書(shū)資料分類法分類號(hào)EvaluationofdeepbrainstimulationtreatmentforParkinson'sdis
3、easebyusingFDGPETGuanyihuiZuochuantaoLidianyouSunbominZhaojunHuafengchunLinxiangtongPETCenter,FunctionalNeurosurgery,HuashanHospitalAffiliatedtoFudanUniversity,Shanghai,200040DepartmentofNeurosurgery,FirsthospitalAffiliatedtoJilinuniversity[Abstract]Objective:Tostudytheeffectsofbilateralsubthal
4、amicnucleus(STN)stimulationoncerebralglucosemetabolismofadvancedParkinson’sdisease,andinvestigatethemechanismofdeepbrainstimulation(DBS).Methods:SevenadvancedParkinson’sdiseasespatientswithbilateralSTNDBSunderwenttwice18F-FDGPETatrestpreoperativelyandonemonthpostoperationwithSTNstimulation-onre
5、spectively.TheunifiedParkinson’sdiseaseratingscale(UPDRS)wasusedtoevaluatetheclinicalstate.Statisticalparametricmapping(SPM)wasusedtoanalysisregionalcerebralmetabolismofglucoseduringbilateralSTNstimulation.Results:BilateralSTNstimulationimprovedtheclinicalsymptomsobviously,whiletheregionalcereb
6、ralmetabolismincreasedinbilaterallentiform,brainstem(midbrainandpon),bilateralpremotorarea,parietal-occipitalcortexandcingulatecortex,anddecreasedinthebottomofprefrontalcortexandhippocampus(p<0.05).Conclusion:BilateralSTNDBSmayactivatetheprojectionaxonfromSTNandimprovedtheclinicalsymptomsofadva
7、ncedPDpatients,whichperhapsimprovebothascendinganddescendingpathwayfromthebasalgangliaandincreasethemetabolismofhigher-ordermotorcontroloffrontalcortex.FDGPETcanbeoneofthesuitblemethodstoselectthecandidatefortheSTN.KeyWordsParkins