脑深部电刺激术治疗节段性颅颈肌张力障碍的临床疗效

Clinical effect of deep brain stimulation on different types of segmental crainocervical dystonia

目的:探讨脑深部电刺激术(DBS)治疗不同类型的节段性颅颈肌张力障碍(SCCD)的临床疗效。方法:回顾性分析2015年3月至2018年9月中日友好医院神经外科收治的80例SCCD患者的临床资料。以眼睑痉挛为主要表现者共33例(41.2%);表现为眼睑痉挛合并口-下颌肌张力障碍者共35例(43.8%);除以上两类表现外,尚合并颈部症状或其他症状者共12例(15.0%),其中8例合并痉挛性斜颈,4例合并构音障碍。所有患者均行双侧以苍白球内侧部(GPi)为靶点的DBS(简称GPi-DBS)治疗。通过临床随访,采用Burke-Fahn-Marsden肌张力障碍评定量表评分(运动部分)(BFMDRS-M)进行术前、术后对比,分析GPi-DBS对不同表现类型SCCD的手术疗效。结果:80例患者中,30例失随访;50例患者获随访,随访时间为(24.5±12.2)个月(4~47个月)。至末次随访,GPi-DBS对SCCD的总有效率为68.0%(34/50),其中以眼睑痉挛为主要表现的SCCD患者的有效率为65.0%(13/20);表现为眼睑痉挛合并口-下颌肌张力障碍的患者的有效率为68.0%(17/25);除以上两类表现外,尚合并颈部症状或其他症状患者的有效比例为4/5。随访的50例患者手术前、后BFMDRS-M评分的差异有统计学意义[分别为(6.3±2.2)分和(4.9±2.5)分,P<0.001],且各表现类型患者的术前、术后BFMDRS-M评分的差异均有统计学意义(均P<0.05)。随访期间除1例出现植入物排异、皮肤破溃外,余49例患者均无手术及硬件相关并发症。结论:GPi-DBS为不同临床表现类型SCCD的有效治疗手段,且并发症少。

Objective To investigate the clinical efficacy of deep brain stimulation(DBS)in the treatment of different types of segmental craniocervical dystonia(SCCD).Methods Clinical data of 80 patients with SCCD admitted to Department of Neurosurgery of China-Japan Friendship Hospital from March 2015 to September 2018 were retrospectively analyzed.There were 33 cases(41.2%)with blepharospasm as the main manifestation.There were 35 cases(43.8%)of blepharospasm with oromandibular dystonia.In addition,there were 12 cases(15.0%)with cervical symptoms and other symptoms,including 8 cases with the comorbidity of spasmodic torticollis and 4 cases with the comorbidity of dysarthria.All patients underwent bilateral GPi(globus pallidus interna)-DBS.During the clinical follow-up,Burke-Fahn-Marsden Dystonia Rating Scale(movement part)(BFMDRS-M)was used for preoperative and postoperative comparison to analyze the surgical efficacy of GPi-DBS for SCCD with different manifestations.Results Out the 80 patients,30 were lost to follow-up and 50 were followed up for 24.5±12.2 months(4-47 months).The total effective rate of GPi-DBS for SCCD was 68.0%(34/50)at the latest follow-up.In this series,the effective rate in patients with blepharospasm as the main manifestation was 65.0%(13/20)and 68.0%(17/25)in those with blepharospasm combined with oromandibular dystonia.In addition,the effective rate of patients with the comorbidity of cervical symptoms or other symptoms was 4/5.The BFMDRS-M scores of 50 patients before and after surgery showed statistically significant differences(6.3±2.2 point and 4.9±2.5 point,respectively,P<0.001),and the preoperative and postoperative BFMDRS-M scores of patients with different manifestations showed statistically significant differences(all P<0.05).During the follow-up,except for 1 case with implant rejection and skin erosion,the remaining 49 patients had no surgical or hardware-related complications.Conclusion GPi-DBS,with few complications,is an effective treatment for various clinical manifestations of SCCD.