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帕金森病吞咽障碍及其神经调控治疗的研究进展
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Abstract:
帕金森病(Parkinson’s Disease, PD)是一种常见的神经退行性疾病，其特征在于运动和非运动症状，吞咽障碍作为一种常见症状，会造成患者药物摄入不足，营养不良，吸入性肺炎等并发症，显著降低患者生活质量。吞咽障碍通常出现在PD晚期，但近年来研究表明，其在PD早期也可能存在，并随病情进展而逐渐加重。PD患者的吞咽障碍机制复杂，涉及多个脑区和神经通路的功能障碍，包括皮质、皮质下、脑干和周围神经系统。目前，针对PD吞咽障碍的治疗方法有限，药物治疗效果不佳，而传统的康复训练效果也存在个体差异。近年来，神经调控技术作为一种新兴的治疗手段，为PD吞咽障碍的治疗带来了新的希望。本综述总结了PD吞咽障碍的流行病学、发病机制以及评估方法的最新研究进展。重点概述了近年来神经调控技术，例如重复经颅磁刺激(Repetitive Transcranial Magnetic Stimulation, rTMS)、经颅直流电刺激(Transcranial Direct Current Stimulation, tDCS)和脑深部电刺激(Deep Brain Stimulation, DBS)等在治疗PD吞咽障碍中的应用现状，并探讨了不同神经调控技术的潜在机制、疗效及安全性，旨在为优化PD患者吞咽障碍的诊疗策略提供科学依据，并为临床实践中有效管理PD患者的吞咽障碍提供参考。
Parkinson’s disease (PD) is a common neurodegenerative disorder characterized by both motor and non-motor symptoms. Dysphagia, as a frequent symptom, can lead to complications such as inadequate medication intake, malnutrition, and aspiration pneumonia, significantly reducing patients’ quality of life. While dysphagia typically manifests in late-stage PD, recent studies suggest its presence in early stages, with progressive worsening as the disease advances. The mechanism of dysphagia in PD patients is complex, involving functional impairments across multiple brain regions and neural pathways, including cortical, subcortical, brainstem, and peripheral nervous systems. Currently, treatment options for PD-related dysphagia are limited, with pharmacological interventions showing poor efficacy and traditional rehabilitation therapies yielding variable individual outcomes. In recent years, neuromodulation techniques have emerged as a promising therapeutic approach, offering new hope for treating dysphagia in PD. This review summarizes the latest research progress on the epidemiology, pathogenesis, and assessment methods of PD-related dysphagia. It focuses on the current applications of neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS), in treating PD-related dysphagia. The review also discusses the potential mechanisms, efficacy, and safety of various neuromodulation techniques, aiming to provide a scientific basis for optimizing diagnostic and treatment strategies for dysphagia in PD patients and to offer reference for effective management of dysphagia in clinical practice for PD patients.
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