脑深部电刺激术治疗舞蹈-棘红细胞增多症的长期随访研究

Long-term outcome of deep brain stimulation in chorea-acanthocytosis

目的总结舞蹈-棘红细胞增多症患者的基因型与表现型特点,探讨双侧内侧苍白球脑深部电刺激治疗术对该疾病的长期疗效。方法收集2016年4月至2018年4月于北京协和医院就诊的7例舞蹈-棘细胞增多症患者,应用全外显子组测序方法对患者进行基因分析,归纳其基因型、表现型特点。所有患者均行脑深部电刺激手术治疗,分别在术前、术后3个月、术后6个月、术后1年、术后3年及术后5年进行长期随访,采用统一亨廷顿病评定量表(UHDRS)对患者进行评分,评估脑深部电刺激手术的长期疗效。结果7例患者以口-舌-面舞蹈症、肢体舞蹈症、肌张力障碍及构音障碍为主要临床表现,基因检测发现所有患者均存在VPS13A基因致病变异,但变异类型各不相同。双侧内侧苍白球脑深部电刺激术前UHDRS的运动评分为(37.00±16.68)分,术后1年的运动评分为(19.67±5.99)分,平均改善46.8%(t=5.20,P=0.003);术后3年的运动评分为(23.86±8.99)分,平均改善35.5%(t=3.08,P=0.022);术后5年的运动评分为(29.00±14.97)分,平均改善21.6%(t=1.41,P=0.217)。患者的症状以肢体舞蹈症及口-舌-面舞蹈症的改善最为显著。在术后5年随访时发现,分别有3例(3/7)患者再次出现严重的肌张力障碍,4例(4/7)再次出现行走困难,患者的构音障碍始终未能得到很好的改善。结论舞蹈-棘细胞增多症患者的临床表现相对一致,但基因变异类型存在明显的差异。双侧内侧苍白球脑深部电刺激术治疗对舞蹈-棘细胞增多症患者有效,但长期疗效随病情进展而降低。

Objective To summarize genotype-phenotype features and explore the long-term outcome of bilateral globus pallidus interna deep brain stimulation(DBS)in chorea-acanthocytosis(ChAc)patients.Methods Seven patients who diagnosed with ChAc were included in this study from April 2016 to April 2018 at Peking Union Medical College Hospital.Whole-exome sequencing was used for gene analysis of the patients,and the genotype-phenotype features of these patients were recorded.All patients underwent the DBS surgery,and long term follow-up was conducted before surgery,3 months,6 months,1 year,3 years,and 5 years after surgery.Patients were scored using the Unified Huntington Disease Rating Scale(UHDRS)to evaluate the long-term efficacy of DBS surgery.Results The main clinical manifestations in all 7 patients were oro-faciol-ingual dyskinesia,limb chorea,dystonia,and dysarthria.Genetic testing found that all patients had VPS13A gene pathogenic variation,but the type of variation was different.The UHDRS motor score before bilateral pallidal DBS surgery was 37.00±16.68,which significantly improved to 19.67±5.99 at 1 year post-surgery,with average improvement of 46.8%(t=5.20,P=0.003),to 23.86±8.99 at 3 years post-surgery,with average improvement of 35.5%(t=3.08,P=0.022),and to 29.00±14.97 at 5 years post-surgery,with average improvement of 21.6%(t=1.41,P=0.217).The symptoms of patients were most significantly improved in limb chorea and oro-facio-lingual dyskinesia.However,at the 5-year follow-up,severe dystonia and gait difficulties reoccurred in 3/7 and 4/7 of the patients,respectively.The patient′s dysarthria had not been effectively improved.Conclusions The clinical manifestations of patients with ChAc are relatively consistent,but there is significant genetic heterogeneity.Bilateral pallidal DBS therapy is effective for patients with ChAc,but the long-term efficacy decreases with disease progression.