苍白球脑深部电刺激术治疗原发性颈部肌张力障碍的疗效分析

Therapeutic effect analysis of pallidal deep brain stimulation for the treatment of primary cervical dystonia

目的探讨苍白球内侧部脑深部电刺激术(GPi-DBS)治疗原发性颈部肌张力障碍的临床疗效。方法回顾性分析2014年10月至2019年4月空军军医大学第二附属医院神经外科采用GPi-DBS治疗的14例颈部肌张力障碍患者的临床资料。术后1个月开机,开机后1、3、6个月,1年及此后每年对所有患者行门诊随访,随访内容包括:观察是否存在硬件相关并发症;行西多伦多痉挛性斜颈评定量表(TWSTRS)[包括:斜颈严重程度量表(TSS)、残疾量表(DS)及疼痛量表(PS)]评分,评估症状改善情况。改善率的计算公式为:(术前评分-术后评分)/术前评分×100%,其中≤30%为轻度改善,>30%~60%为中度改善,>60%为显著改善。结果14例患者的手术均顺利完成,术后均无颅内出血、感染等手术相关并发症。14例患者共植入28侧电极,其中13侧采用单负极刺激模式,15侧采用双负极刺激模式。14例患者的随访时间为开机后(33.7±12.4)个月(12~53个月)。随访期间,2例患者出现下肢运动异常,通过调整刺激参数症状得到改善。随着随访时间延长,TSS、DS及PS评分均呈降低的趋势(均P<0.001);斜颈症状、残疾程度及疼痛症状均自开机后3个月开始显著改善;末次随访时,TSS、DS、PS评分与开机后1年的评分比较,差异均无统计学意义(均P>0.05)。至末次随访,14例患者的TSS评分结果为,1例轻度改善、6例中度改善、7例显著改善;DS评分结果为,2例轻度改善,2例中度改善,10例显著改善;PS结果为,14例均显著改善。结论GPi-DBS治疗原发性颈部肌张力障碍的并发症发生少、斜颈和疼痛症状改善明显,且疗效持续时间较长。

Objective To investigate the clinical efct of deep brain stimulation(DBS)of the globus pallidus internus(GPi-DBS)for the treatment of primary cervical dystonia.Methods The clinical data of 14 patients with cervical dystonia treated with GPi-DBS in the Neurosurgery Department of the Second Affiliated Hospital of Air Force Medical University from October 2014 to April 2019 were retrospectively analyzed.The device of DBS was turned on at 1 month after the operation,and all patients were followed up in outpatient clinics at 1,3,6 months,1 year and every year thereafter.Follow-up contents included:observation of hardware-related complications;the Toronto Western Spasmodic Torticollis Rating Scale(TWSTRS)[including:Toricollis Severity Scale(TSS),Disabilty Scale(DS)and Pain Scale(PS)]score to assess the improvement of the patient's symptoms.The calculation formula of improvement rate was:(preoperative score postoperative score)/preoperative score x 100%,of which≤30%was regarded as mild improvement,>30%-60%as moderate improvement,and>60%was significant improvement.Results All 14 patients underwent successful operations,and there were no postoperative complications such as intracranial hemorhage and infection.A total of 28 electrodes were implanted(on 28 sides),of which the monopolar stimulation mode was applied in 13 electrodes,and the double-monopolar(two cathodes)stimulation mode in 15 electrodes.The follow-up time of 14 patients was 33.7±12.4 months(12-53 months)after the DBS device was turned on.During the follow-up period,2 patients developed dyskinesia in the lower extremities,and the symptoms were improved by adjusting the stimulation parameters.With the extension of follow-up time,TSS,DS and PS scores all showed a decreasing trend(all P<0.001);torticollis symptoms,disability and pain symptoms were significantly improved 3 months after the device was turned on.At the last follow-up,there was no statistically significant difference in the TSS,DS or PS scores compared with the patients'conditions at 1 year after the device was turned on(all P>0.05).At the last follow-up,the TSS scores of 14 patients were as follows:1 case was mildly improved,6 cases were moderately improved,and 7 cases were significantly improved.In the DS score results,2 cases were mildy improved,2 cases were moderately improved,and 10 cases were significantly improved.In the PS results,14 cases were significantly improved.Conclusion GPi-DBS treatment of primary cervical dystonia has fewer complications,significant improvement in torticollis and pain symptoms,and prolonged effect.