关键词: 帕金森病, 丘脑底核, 脑深部电刺激术, 平衡, 药物治疗, 康复治疗, 心理治疗

Abstract: Objective To investigate the effect of multi-disciplinary teamwork on balance performance in Parkinson′s disease （PD） with bilateral STN-Deep Brain Stimulation. Methods 16 primary Parkinson′s disease（8 male,8 female） treated with bilateral subthalamic nucleus deep brain stimulation（STN-DBS） were included in the study. The median age of patients was 60.5 years; all patients were in H&Y 3 stage; the median PD duration of the disease was 9 years. For each patient, multi-disciplinary teamwork treatment including DBS, medication, physical therapy and psychotherapy was proceeded. LEDD, Motor disability（MDS-UPDRSIII）, life quality （PDQ-39） and balance performance（MDS-UPDRS 3.12, Berg Balance Scale, BBS Limits of Stability, LoS） were assessed in different time and status respectively： pre-operation （Med-off,Med-on）, post-operation （Stim-Off/Med-Off, Stim-On/ Med-Off, Stim-On/Med-On）, 6 months postoperation （Stim-On/ Med-Off, Stim-On/ Med-On） and 12 months postoperation （Stim-On/Med-Off, Stim-On/Med-On）. Results The LEDD of the 16 patients was significantly decreased during the follow-up （P<0.05）. The life quality （PDQ-39） score was significantly improved during the follow-up （P<0.05）. The Motor disability （MDS-UPDRSIII） was significantly improved in the postoperation Stim on/Med off state（P<0.05）, the MDS-UPDRS III score was optimal at 12 months postoperation （P<0.05）. Balance-related scores （MDS-UPDRS, item 3.12 and BBS） showed no significant improvement （P>0.05） compared with preoperation Med-off,postoperation Stim on/Med off, and Stim on/Med off state at 6 months postoperation. The scores were statistically different （P<0.05）, and the scores of Stim on/Med off state continued to improve at 12 months postoperation （P<0.05）. The limit of stability assessment of postoperation Stim on/Med off state （target acquisition percentage, body swing angle standard deviation, time） were significantly improved （P<0.05） compared with the preoperation Med off, preoperative Med on and postoperation Stim-off/Med-off. Conclusion Multi-disciplinary teamwork for PD patients with STN-DBS could improve balance performance.

Key words: Parkinsons disease, Subthalamic nucleus, Deep brain stimulation, Balance, Medication, Rehabilitation, Psychotherapy