【摘要】 目的探讨中央丘脑脑深部电刺激(deep brain stimulation,DBS)治疗长期意识障碍的时机、评估标准和疗效。方法回顾性分析17例采用DBS治疗的长期意识障碍病例资料,其中创伤性颅脑损伤8例,非创伤性颅脑损伤9例。应用临床行为、电生理和PET-CT评估脑干网状结构-丘脑-大脑皮质功能。DBS治疗靶点为中央丘脑。结果病人均临床随访1年。8例创伤性颅脑损伤病人中,有效5例,改善3例;9例非创伤性颅脑损伤病人中,有效3例,改善2例,无效4例;总体有效率为47.1%(8/17)。17例病人DBS治疗1年后,昏迷恢复量表修订版(CRS-R)评分较入院时均有显著提高(P <0.05)。术前PET-CT代谢保留是影响病人预后的重要因素(P <0.05)。结论长期意识障碍病人如果符合临床行为评估、电生理和脑代谢的手术入选标准,DBS可作为治疗意识障碍的有效手段。更多还原

【Abstract】 Objective To investigate the opportune time, evaluation criteria and therapeutic effect of central thalamic deep brain stimulation(DBS) for treatment of prolonged disorder of consciousness. Methods The clinical data of 17 patients with prolonged disorder of consciousness undergoing DBS were analyzed retrospectively, including 8 with traumatic brain injury and 9 with non-traumatic brain injury. Neurological evaluation, electrophysiological evaluation, and the results of positron emission tomography-computed tomography(PET-CT) were used to evaluate the function of the brainstem reticular formation, thalamus and cerebral cortex. The target of DBS treatment was central thalamus. Results All the patients were followed up for 1 year. Among the 8 patients with traumatic brain injury, the stimulation was effective in 5 cases, and the symptoms were improved in 3; and in 9 patients with non-traumatic brain injury, effective in 3, improved in 2 and ineffective in 4. The overall response rate was 47.1%(8/17). After 1 year of DBS treatment in 17 patients, the Coma Recovery Scale-Revised(CRS-R) was significantly higher than that at admission(P < 0.05).Preoperative PET-CT metabolic retention was an important factor affecting the prognosis of patients(P < 0.05). Conclusions If the patients with prolonged disorder of consciousness fulfill the selection criteria of clinical behavior evaluation, electrophysiology and brain metabolism, DBS may be an effective method to treat disorder of consciousness.更多还原