脑深部电刺激治疗肌张力障碍

Deep brain stimulation for dystoula

目的探讨脑深部电刺激术（deep brain stimulation，DBS）治疗全身性、偏身性和节段性肌张力障碍的有效性和安全性，肌张力障碍患者治疗和术后程控的策略。方法采用微电极记录下丘脑底核（subthalamic nucleus，STN）、苍白球内侧部（globus pallidus internus，GPi）和丘脑腹中间核（ventrointermediate nucleus，Vim）埋置脑深部刺激器治疗肌张力障碍患者15例，同时记录患者对侧受累肌肉的电活动。其中13例患者的刺激靶点为STN（11例为双侧，2例为单侧），1例刺激靶点为单侧GPi，1例为Vim。结果除1例严重全身肌张力障碍患者外，其余患者因随访时间长短，均有不同程度改善，改善率从22．0％～95．8％不等。其中随访时间超过12个月的患者症状改善率均大于48．6％。1例因全身扭动造成电极外露，颈、胸腹部切口感染，最终将DBS装置取出。另有1例患者因双侧上端的两个触点断路，再次手术将电极位置上移。所有患者均未出现因穿刺造成的颅内出血的永久并发症。结论通过对现有DBS治疗肌张力障碍病例资料有效性和安全性的总结，DBS成为治疗肌张力障碍的一种新方法。

Objective High-frequency deep brain stimulation （DBS） of the subthalamic nucleus （ STN）, globus pallidus internus （GPi） and thalamic Vim is a new and promising treatment option for severe dystonia. We present the results of DBS of the STN, GPi and Vim in 15 patients with severe dystonia of different causes and programming all patients after operation. Methods In our study, we included 12 patients with primary generalized dystonia, three patients with secondary generalized dystonia. 13 patients DBS electrodes were implanted within STN （11 patients within bilateral and two within unilateral） , one case within unilateral-GPi and one case within unilateral-Vim. The follow-up time was range 1-20 months. Preoperative and postoperative evaluations were performed using the Burk-Fahn-Marsden scale. Results Except for one case, all patients showed inhomogeneous improvement （ 22. 0% - 95. 8% ）. The best improvement was achieved in patients with primary dystonia. One case pulled out the DBS equipment at last due to incisions infection. Conclusion DBS is a new and promising treatment option for dystonia.