脊髓电刺激术治疗遗传性脊髓小脑性共济失调1例报道并文献复习

Clinical efficacy of spinal cord stimulation for gait dysfunction in patients with hereditary spinocerebellar ataxia type 6:report of one case and literature review

目的 探讨脊髓电刺激术(SCS)治疗遗传性脊髓小脑共济失调(SCA)步态障碍的有效性及可行性。方法 回顾性分析2021年7月SCS治疗的1例6型遗传性SCA(SCA-6型)的临床资料,并结合文献进行复习。结果 成功实施SCS,电极靶点设置在T9~11硬脊膜外间隙,在神经电生理监测下将电极调整至生理中线处。术后复查胸椎CT并三维重建示电极位置满意,术后2周开机行电刺激,制定个体化调控方案。术后1个月,开机状态下,病人步态不稳及平衡障碍明显改善。术后7个月,Tinetti步态与平衡试验量表评分由术前14分提升到24分;Barthel指数由40分提升至80分。术后1年,Tinetti步态与平衡试验量表评分达到25分,Barthel指数提升至85分。结论 我们探索性地将SCS应用于SCA病人,术后病人步态及平衡障碍显著改善。这为步态障碍病人提供了一种可行的、有效的治疗方式。由于目前国内尚无相关报道,这方面的经验尚少,需进一步开展多中心的临床随机对照研究,验证SCS治疗步态障碍的疗效,并探索最佳靶点位置、刺激参数等,以更好地帮助共济失调病人改善症状。

Objective To observe the therapeutic effect of spinal cord stimulation(SCS) on gait disorders in the patients with hereditary spinocerebellar ataxia type 6(SCA-6). Methods The clinical data of one patient with SCA-6 who underwent SCS on July 22,2021 were analyzed retrospectively. The relative literatures were reviewed. Results SCS was successfully performed on the patient.Medtronic electrode was placed at the epidural T9~11level, and adjusted to the physiological midline under neuroelectrophysiological monitoring during the operation. Surgery was well-tolerated without complications. Postoperative CT scan and 3D reconstruction images of thoracic spine showed that the electrode position was satisfactory. Electrical stimulation was performed at 2 weeks after the operation,and individualized mode of stimulation was designed based on the patient’s condition. A clinically meaningful improvement in gait and balance function of the patient was achieved on stimulation condition 1 month after the operation. Seven months after the operation, the Barthel index increased from 40 to 80, and the Tinetti score increased from 14 to 24. One year after the operation, the Tinetti score reached 25, and the Barthel index increased to 85. Conclusions We successfully applied SCS to one SCA patient, and the gait disorders of the patient were significantly improved after the operation. This provides a feasible and effective treatment for gait disorder patients.Since there is currently no relevant report in China, and there is little experience in this area, it is necessary to further conduct multicenter randomized controlled clinical trials to verify the efficacy of SCS for the gait disorders, and to explore the best target location,stimulation parameters, etc., in order to improve the symptoms of ataxia patients.