巴金森氏症的深腦電刺激治療

Deep Brain Stimulation for Parkinson's Disease

戴春暉(Chun-Hwei Tai) ； 曾勝弘(Sheng-Hong Tseng)

《台灣醫學》 27卷2期 (2023/03) Pp. 187-196

https://doi.org/10.6320/FJM.202303_27(2).0009

摘要

巴金森氏症早期主要倚靠多巴胺相關的藥物治療，然而當進入病程的中後期，患者常會出現劇烈的藥效波動及各種藥物併發症，導致巴金森氏症病患及家屬遭受很大的痛苦，深腦刺激治療就是在這種藥物治療的困境下，應運而生的嶄新治療方式。深腦刺激治療藉著輸入電流調控大腦運動迴路中的不正常神經訊號，可以治療巴金森氏症的動作障礙症狀，進一步也改善了藥效波動的現象，不但降低病患對藥物的依賴，還可減少異動症的發生，可說是大幅提升了中後期巴金森病患的治療效果和生活品質。自2015年，我國的全民健康保險開始給付深腦刺激手術治療巴金森氏症，也因此這個治療已經成為今日巴金森氏症病患的標準治療項目。整個深腦刺激治療從篩選病患起、經過手術過程、到術後的電刺激器操作，過程十分繁複，需要一個具足夠能力和經驗的團隊方能順利進行。本文章將帶大家由巴金森氏症深腦刺激治療的各種面向，包括治療機轉及時機、適應症和禁忌症、進行的技術與方法、治療的效果和潛在副作用，以及未來發展的重要趨勢等，希望以深入淺出的方式，來幫大家更了解深腦刺激這個劃時代的新療法。

關鍵字

巴金森氏症 ； 深腦刺激治療 ； 動作障礙疾病 ； 視丘下核

並列摘要

In the early stage of Parkinson's disease (PD), it mainly relies on dopamine-related drugs for treatment, but when the course of the disease enters the middle and late stage, patients often experience severe fluctuations in drug efficacy and various drug complications, causing major sufferings in Parkinson's disease patients and their families. Deep brain stimulation therapy (DBS) is a brand-new treatment method born under the plight of drug treatment. DBS therapy delivers electrical current into certain brain regions to regulate abnormal nerve signals in the motor circuit. In addition to treat the motor symptoms of PD movement disorders, DBS also improves the fluctuation of drug effects, reduces the patient's dependence on drugs, and ameliorates the occurrence of dyskinesia, which greatly improves the efficacy of treatment and quality of life in PD patients. Our country's National Health Insurance has also started to pay for DBS treatment of PD since 2015, so today this treatment has become a standard treatment option for PD patients in Taiwan. The whole process of DBS treatment is very complicated, from the screening of patients, through the operation process, to the operation of the pulse generator after surgery, which requires a team with sufficient ability and experience to proceed this process smoothly. This article will take you through various aspects of deep brain stimulation treatment for Parkinson's disease, including DBS mechanism, the timing of treatment, indications and contraindications, surgical techniques, treatment effects and potential side effects, as well as important DBS trends in future development, to help everyone understand this epoch-making new therapy for PD.

並列關鍵字

Parkinson's disease ； deep brain stimulation ； movement disorder ； subthalamic nucleus

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