苍白球内侧核脑深部电刺激联合内囊前肢毁损术治疗Meige综合征的长期疗效评估

Long-term efficacy of deep brain stimulation of the globus pallidus internas combined with bilateral anterior internal capsulotomy for Meige syndrome

目的探讨苍白球内侧核脑深部电刺激(GPi-DBS)联合双侧内囊前肢毁损术(BAIC)治疗Meige综合征的长期疗效。方法回顾性分析19例Meige综合征病人的临床资料,行GPi-DBS联合BAIC治疗,术前及术后不同时间段(3、6、12、18、24、36个月)采用肌张力障碍运动评分量表(BFMDRS)、Yale-Brown强迫症状量表(Y-BOCS)、Hamilton抑郁症状量表(HAMD)、Hamilton焦虑症状量表(HAMA)评分,评价手术疗效。结果术后18个月,共随访19例病人,术后3、6、12、18个月BFMDRS评分较术前明显下降(P<0.05),术后12、18个月Y-BOCS、HAMA、HAMD较术前明显下降(P<0.05);术后3、6、12、18个月BFMDRS评分平均改善率分别为69.8%、71.6%、72.1%、73.2%。术后24个月,共随访11例病人,BFMDRS、Y-BOCS、HAMA、HAMD术后评分较术前明显下降(P<0.05);BFMDRS评分平均改善率为76%。术后36个月,随访3例病人,BFMDRS评分平均改善率为97.5%。1例随访48个月,肌张力障碍症状完全消失,同时强迫、焦虑、抑郁症状明显改善。病人均未出现颅内出血、感染及严重刺激相关并发症。结论 GPi-DBS联合BAIC治疗Meige综合征的长期疗效显著,并发症少,同时明显改善病人的焦虑、抑郁症状,是一种安全有效的治疗方法。

Objective To explore the long-term efficacy of deep brain stimulation of the globus pallidus internas （GPi-DBS） combined with bilateral anterior internal capsulotomy （BAIC） in the treatment of Meige syndrome. Methods Clinical data of 19 patients with Meige syndrome were analyzed retrospectively, who underwent GPi-DBS combined with BAIC. The Burke-Fahn-Marsden Dystonia Rating Scale （BFMDRS）, Yale-Brown Obsessive-Compulsive Symptom Scale （Y-BOCS）, Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA） were used to evaluate and compare the surgical outcomes before and 3, 6, 12, 18, 24, 36 months after surgery. Results The 19 patients were followed up for 18 months, and the BFMDRS scores 3, 6, 12, 18 months after surgery were significantly decreased compared with presurgery （P〈0.05）, and the mean improvement rate of BFMDRS scores were 69.8%, 71.6%, 72.1%, 73.2%respectively 3, 6, 12, 18 months after surgery. The Y-BOCS, HAMA, HAMD scores 12 and 18 months after surgery were significantly decreased compared with presurgery （P〈0.05）. Eleven patients were followed up for 24 months and the above four scores 24 months after surgery were significantly decreased compared with presurgery （P〈0.05）, and the mean improvement rate of BFMDRS score was 76%. Three patients were followed up for 36 months and the mean improvement rate of BFMDRS score was 97.5%. One patient was followed up for 48 months and the dystonia symptom disappeared completely and the other symptoms such as obsessive-compulsive, anxious and depressive symptoms were improved significantly. There was no intracranial hemorrhage or serious irritation-related complications in all the patients. Conclusions GPi-DBS combined with BAIC is a safe and effective method for the treatment of Meige syndrome, and its long-term efficacy was significant with less complications and can significantly improve the anxious and depressive symptoms.