事件记录
Dr. 米勒: Advanced Parkinson's disease and movement disorders. We're going to talk about what to do next on 范围 radio. 我是汤姆·米勒.
播音员: Access to our experts with in-depth information about the biggest health issues facing you today. 专家与博士. 汤姆米勒在范围报道.
帕金森病的治疗
Dr. 米勒: 嗨，今天和我在一起的是Dr. 劳伦·施洛克. 她是一名助理教授 神经学 并负责 运动障碍项目. Lauren, we're going to talk about sort of 先进的帕金森氏症. I think it's pretty well known that after a period of time, 很多对药物治疗有反应的人开始对药物治疗效果不太好. 我想今天大发娱乐想和大家讨论的是有新的治疗方法，包括 深部脑刺激. 病人应该什么时候开始考虑这种治疗方法如果他们考虑这种治疗方法他们应该和谁一起工作?
Dr. 施洛克: 当药物开始引起并发症时这通常是大发娱乐在帕金森专家中使用的术语. 基本上, 随着时间的推移, 药物不会持续很长时间，而且在每次给药之间会逐渐消失，人们可能会出现运动障碍.
Dr. 米勒: 是的, what is a dyskinesia for our listeners?
Dr. 施洛克: Dyskinesia is an extra involuntary movement. It almost looks like a wiggling and a squirming. The most known person who most people have seen have this issue publicly would be Michael J. 狐狸. 来回摆动. 这可能是由患有帕金森病和服用帕金森病药物共同引起的.
Dr. 米勒: Did Mohammed Ali have a 深部脑刺激 device implanted? 你知道吗？?
Dr. 施洛克: No. 据我所知，穆罕默德·阿里没有. 他的帕金森氏症可能被认为是继发性帕金森氏症，与头部多次受到撞击有关. 就是那种帕金森病, 这是由别的东西引起的, it's not expected to respond to 深部脑刺激.
Dr. 米勒: 好吧. 很高兴知道.
深部脑刺激治疗帕金森症
Dr. 施洛克: Very important point about when a person is considering, "Should I have 深部脑刺激?“因为有很多东西可以预测一个人是否会对深部脑刺激做出良好反应，以及他们之后的表现如何.
Dr. 米勒: So tell us about how someone makes the decision about inquiring on this new type of treatment.
Dr. 施洛克: I'm going to actually start with one and explain what it is a little bit more. If you imagine almost like a brain pacemaker, in the same way that people have pacemakers to help their heart keep beating, 在帕金森氏症中，有一种叫做深部脑刺激的方法，在大脑深处放置一根电线. When it's in place it's often not very visible. 一些 神经外科医生 会关注它的美学和其他人对它的设计方式的看法吗, 可以这么说.
深部脑刺激, 你要做的第一件事是当你考虑问这个问题是否合适的时候，你要去看帕金森病的专家. 这是一种 神经学家 who specifically has done specialized training in things like Parkinson's disease and tremors.
Dr. 米勒: Both medications and in the 深部脑刺激.
Dr. 施洛克: 绝对. 是的，在药物方面. Because many of my colleagues, who are involved heavily in D.B.S., 像我这样, 最重要的是去看帕金森症专家或者大发娱乐称之为运动障碍专家. It's not uncommon for me to be able to work with a patient and actually say, "Oh, why don't you try this medication change,“然后他们打电话说, "Oh, 取消那个神经外科的想法,这就是深部脑刺激.
Dr. 米勒: 也就是说你和植入深部脑刺激装置的外科医生关系密切. 对吗？?
Dr. 施洛克: 绝对.
Dr. 米勒: 所以你要和他们紧密合作为病人设计治疗方案.
Dr. 施洛克: 绝对, because our goal is to have good outcomes in all patients we select. So we have special selection procedures to be able to ensure that, voiding any complications with the surgery as can happen with any type of surgery, 病人会做得很好他们想要改善的症状也会得到改善.
谁是星展计划的好候选人?
Dr. 米勒: Now what percentage of patients that you see will benefit from a 深部脑刺激 device?
Dr. 施洛克: 通常, when we think about a patient who's going to be ready for 深部脑刺激, 是否有人尽管优化了他们的药物，但却经历了很多起伏，药物逐渐失效，他们患上了运动障碍. They also have not developed significant problems with memory and thinking. 在D的早期.B.S. 大多数中心会说，他们的病人中可能有10%的人被推荐进行深部脑刺激实际上是候选人.
Dr. 米勒: 十分之一.
Dr. 施洛克: 是的.
Dr. 米勒: 十分之一. 好吧.
Dr. 施洛克: 然而, 我想说的是，大发娱乐的区域神经学家在大发娱乐受过良好的教育我想说的是，70%的病人是专门为深部脑刺激问题转介给我的最后在转介后的两年内进行了深部脑刺激. 所以我在大发娱乐真的感到很幸运. We have great 神经学家s in the area who really know what the indications are for the therapy.
DBS外科手术
Dr. 米勒: 一旦把这个放进去，你就可以, just like with a pacemaker for the heart, to make adjustments in the way that you'd provide the treatment.
Dr. 施洛克: 是的,绝对. So this is not a straight forward, like a medication sometimes can be. 你得到的是, 深部脑刺激, 你把导线插入大脑中一个3 × 6 × 6毫米的目标. That target in the brain has several different sub areas that we have to get into. 所以大发娱乐必须进入小运动区域所以任何超过2毫米的误差都是手术成功和失败的区别. 所以我非常依赖技能, 优秀的技能, of the surgeon for my ability to have great outcomes.
Dr. 米勒: 你说结果很好. 跟我说说这个吧，因为你现在有了一个对药物有抗药性的人. They've got 的运动困难 as you've mentioned. 如果成功了，他们认为会发生什么?
Dr. 施洛克: This only helps with what they call the motor symptoms of Parkinson's disease. So 深部脑刺激 helps with tremor, 运动缓慢, stiffness in the muscles as well as dyskinesias. 所以如果你想象一个患有帕金森病的人已经服用了几年的药物, when the medications now are only lasting every two to three hours, some people only one hour before they wear off, 他们不能指望任何确定的时间. They can't go to a play and expect to be able to . . . they don't know if they're going to be able to get up and go home.
所以深部脑刺激能做的是通过大发娱乐控制这些症状，它真的能给人一天的信心. That they're not going to go somewhere and get stuck. 他们不会去某个地方，然后开始出现这些让他们尴尬的运动障碍. So really it's more of a smoothing out of the symptoms during the day.
星展银行的好处
Dr. 米勒: How long can one expect to see that benefit from the deep brain stimulator?
Dr. 施洛克: 越来越多的研究关注时间的长短以及随着时间的推移，哪些症状会得到缓解. 早期的研究是在一到三年之后进行的，结果显示这种疗法的效果非常好. Then we have now five-year and some 10-year studies. What they show for the symptoms that we expect it to benefit such as tremor, 的运动困难, those continue to be well controlled even at 10 years.
在脑深部刺激之后大发娱乐通常会立即减少30%到80%的药物用量但大发娱乐必须随着时间的推移逐渐增加药物用量. What does gradually get worse is the 运动缓慢. We aren't able to keep up with that as much as we are with tremor. D的症状.B.S. doesn't help in the first place and those include balance, 演讲, freezing of gait where they get stuck and they can't keep moving, 以及记忆和思考问题. 所以所有这些D.B.S. didn't help in the beginning, at 10 years out those are the major issues.
Dr. 米勒: But still, this is a great therapy to help people live a better life.
Dr. 施洛克: 绝对. 就生活质量而言, 所有对帕金森病患者进行药物优化或最佳药物管理与深部脑刺激的比较研究都表明，帕金森病患者的生活质量要高得多.B.S. 与单纯的药物相比. 许多病人会向我解释，他们感觉自己的疾病倒退了5年或10年.
Dr. 米勒: 这听起来就像如果你是一个帕金森患者或者一个医生在照顾一个帕金森患者他们开始出现运动障碍他们一直在服用药物他们一直在增加药物的剂量但情况并没有好转, it probably is time to consider referring them to a movement disorder specialist in 神经学.
Dr. 施洛克: 越早转介越好，因为大发娱乐永远不会在需要手术之前就推荐手术，大发娱乐总是可以大发娱乐提供教育，这样你就知道什么时候是合适的.
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更新日期：2019年4月16日
最初发布日期：2014年5月13日