When to start the operation after DBS in patients with primary Parkinson’s disease?How to cooperate with medicine after boot?

2022-05-01 0 By

In August 2021, Guangdong Provincial Medical Security Bureau issued the “Catalogue of Medical Consumables for Basic Medical Insurance, Industrial Injury Insurance and Maternity Insurance in Guangdong Province (2021)”, in which deep brain stimulation (DBS) surgery, which patients with Parkinson’s disease are most concerned about, is covered by medical insurance.56, ms Chen became our first the policy benefit patients, she have almost 10 years of the course, and there have been decreased drug efficacy and agent at the end of the phenomenon, drug failure occurs when the lower extremities step, difficulty walking, glossolalia symptoms, take medicine again after 1 hour and there will be movement disorder, twisting of the head and upper limb is not independent, although the symptoms are not serious,But as far as outsiders can see.However, Ms. Chen is outgoing and lively. She likes making friends and traveling everywhere. Every time at the end of the medication, walking difficulties and dyskinesia of the medication peak will trouble her.After seeing the documents issued by Guangdong Provincial Medical Insurance Bureau, she immediately consulted me in the outpatient department. Due to the long-term follow-up, I had a very good understanding of her condition. After a brief review of the disease course and physical condition, I suggested her to have a preoperative screening of DBS in the outpatient department.This screening is very important to her, and can be completed in outpatient service, we use a morning time tracking her changes before and after medication, made a series of scale tests, the results showed her levodopa impact test period is 56% (DBS surgery must be > = 30%), and then arranged for her to the hospital, because each process has arranged prior to admission,So everything went well and the operation ended safely.Next, Ms. Chen is most concerned about when she can enjoy the improvement brought by electronic medicine, which is estimated to be the most anticipated problem for Parkinson’s patients and doctors.Now let’s talk about the program control after DBS operation. The program control of patients with primary Parkinson’s disease after surgery is one of the most important links. Standardized and reasonable parameter adjustment can improve symptoms and improve the quality of life of patients.Postoperative DBS can include the early postoperative stage and the long-term follow-up stage.1. The early postoperative stage (1 week) after the majority of patients anesthesia can be up to the next day after waking activity, then though machine has not started, but will feel than before surgery in patients with Parkinson’s symptoms have improved, the body will have a light touch, this is because the DBS electrodes into the brain nuclei have the effect of the slight damage.Whether to maintain the preoperative drugs depends on the condition, which is generally divided into the following three conditions :(1) for patients with preoperative dyskinesia, the dosage of anti-parkinson’s disease drugs, especially compound levodopa, can be appropriately reduced under the guidance of doctors;(2) For patients with significant preoperative motor symptoms such as stiffness, tremor and walking difficulty, it is recommended to maintain the preoperative drug dose;(3) Postoperative delirium, lethargy, and worsening of mental symptoms may occur in the near term. For other anti-PD drugs other than compound ledopa (such as dopamine receptor agonists, amantadine, and benheisol hydrochloride, etc.), unless they are the main drugs for controlling movement disorders before surgery, it is suggested to reduce or suspend their use under the guidance of doctors.2. In the early period after DBS operation (1 ~ 4 weeks after operation), patients will feel stiff and sluggish again. That is, the micro-damaging effect of implanted electrode gradually fades, the wound gradually heals, and the patients who have reduced the dosage of drugs can gradually resume the preoperative medication regimen.However, for PD patients with serious end-drug phenomena before and after surgery, the dosage and variety of drugs may be increased.3. After DBS startup (2~4 weeks after operation), the patient enters the long-term treatment period of DBS.Prior to the program, the doctor will order the patient to review the MRI or CT scan to determine whether the electrode is in good position.DBS patients with postoperative reviewed mri of the brain, determine the electrode inside the STN nuclei, and good position on the day of the boot, program-controlled doctors will inform patients stop taking against Parkinson’s disease, especially stop taking compound levodopa for 12 hours, SPC after breakfast to the court that day, because the first boot, the resistance of the need to test machine, machine access connection is complete,Each contact is tested one by one to observe the tolerance range that can be regulated by patients, whether there are adverse reactions, and to find the best contact. The process is tedious and requires the patient and meticulous operation of experienced program control doctors.One month after DBS surgery, the doctor and the program control doctor help the patient to start up together. 4. Long-term follow-up stage After routine DBS start-up stimulation, the motor and non-motor symptoms of the patient will be tracked by the experts of motor disorders in the department of neurology, so as to determine the combination of DBS stimulation parameters and the type and dose of anti-PD drugs.(1) If conventional STN-DBS parameters can fully control PD symptoms, patients can maintain a good quality of life, and there is no significant DBS directly related complications, anti-PD drugs can be gradually reduced.After STN-DBS, the equivalent dose of levodopa can be reduced by 30% ~ 50% on average.For PD patients receiving GPI-DBS, the postoperative drug dose is similar to that before surgery, so it is not recommended to reduce the drug dose.(2) If DBS parameters reach the upper limit of the commonly used parameter range (for example, increasing the parameters may significantly increase power consumption, except for rechargeable DBS), or adverse reactions of DBS occur, it is not suitable to further improve DBS parameters. It is suggested to adjust anti-PD drugs after DBS program control reaches a stable state.If you like my work, please remember to like, follow and forward!Follow @Shennei Deputy chief physician Li Mengyan, take you to know more medical science knowledge!# Parkinson’s ##DBS surgery ##DBS## Stereo-guided deep brain stimulator implantation #