脑深部电刺激治疗肌张力障碍的疗效分析

Curative effect of deep brain stimulation of different targets on myodystonia

目的探讨脑深部电刺激（DBS）丘脑底核（STN）与苍白球内侧部（Gpi）治疗肌张力障碍的疗效。方法采用STN-DBS与Gpi-DBS治疗肌张力障碍患者34例,术后1、3、6、12和24个月采用Burke-Fahn-Marsden（BFM）肌张力障碍量表评估疗效。结果 34例患者均顺利完成DBS,其中4例未获得缓解和1例因术后感染行二次手术取出刺激装置。29例患者二期手术开机后随访1~2年,症状均得到不同程度的改善,其中21例原发性患者疗效较好,术后BFM运动评分及残疾评分均较术前有明显改善（P〈0.05）。继发性患者行DBS术后上述两项评分有所下降,但较术前比较改善不明显。结论 STN-DBS与Gpi-DBS对原发性肌张力障碍患者疗效明显,对继发性患者疗效差。两个靶点刺激均可使肌张力障碍得到不同程度改善,患者STN-DBS比GPi-DBS术后较早期获得改善。

Objectives To compare the curative effect of deep brain stimulation （DBS） of subthalamic nucleus （STN-DBS） with that of DBS of globus pallidus pars internus （Gpi-DBS） on myodystonia and to explore the DBS indications. Methods Of 21 patients with primary myodystonia, 10 were treated by Gpi-DBS and 11 by STN-DBS. Of 8 patients with secondary myodystonia, 4 were treated by Gpi-DBS and 4 by STN-DBS. Burke-Fahn-Marsden dystonia rating scales （BFMDRS） were determined before the operation and 1, 3, 6, 12 and 24 months after the operation in all the patients in order to assess their curative effects on the myodystonia. Results BFMDRS scores were significantly lower after the operation than those before the operation in patients with primary myodystonia treated by Gpi-DBS or STN-DBS （P〈0.05）. BFMDRS scores were significantly lower in the patients with primary myodystonia treated by STN-DBS than those in the patients with primary myodystonia treated by Gpi-DBS 1, 3 and 6 months after the operation （P〈0.05）, but there was insignificantly difference in BFMDRS scores between both the groups 12 and 24 months after the operation （P〉0.05）. BFMDRS scores were reduced by STN-DBS or Gpi-DBS in the patients with secondary myodystonia, but there was insignificantly difference between the preoperative BFMDRS scores and the postoperative BFMDRS scores （P〉0.05）. Conclusions The curative effects of STN-DBS and Gpi-DBS on patients with primary myodystonia are good, but the curative effect of STN-DBS was significantly better than that of Gpi-DBS early after the operation in the patients with primary myodystonia.