Non-invasive brain stimulation to promote motor and functional recovery following spinal cord injury

We conducted a systematic review of studies using non-invasive brain stimulation（NIBS： repetitive transcranial magnetic stimulation（r TMS） and transcranial direct current stimulation（t DCS）） as a research and clinical tool aimed at improving motor and functional recovery or spasticity in patients following spinal cord injury（SCI） under the assumption that if the residual corticospinal circuits could be stimulated appropriately, the changes might be accompanied by functional recovery or an improvement in spasticity. This review summarizes the literature on the changes induced by NIBS in the motor and functional recovery and spasticity control of the upper and lower extremities following SCI.

Non-invasive electrical brain stimulation:from acute to late-stage treatment of central nervous system damage

Non-invasive brain current stimulation（NIBS） is a promising and versatile tool for inducing neuroplasticity,protection and functional rehabilitation of damaged neuronal systems.It is technically simple,requires no surgery,and has significant beneficial effects.However,there are various technical approaches for NIBS which influence neuronal networks in significantly different ways.Transcranial direct current stimulation（t DCS）,alternating current stimulation（ACS） and repetitive transcranial magnetic stimulation（r TMS） all have been applied to modulate brain activity in animal experiments under normal and pathological conditions.Also clinical trials have shown that t DCS,r TMS and ACS induce significant behavioural effects and can – depending on the parameters chosen – enhance or decrease brain excitability and influence performance and learning as well as rehabilitation and protective mechanisms.The diverse phaenomena and partially opposing effects of NIBS are not yet fully understood and mechanisms of action need to be explored further in order to select appropriate parameters for a given task,such as current type and strength,timing,distribution of current densities and electrode position.In this review,we will discuss the various parameters which need to be considered when designing a NIBS protocol and will put them into context with the envisaged applications in experimental neurobiology and medicine such as vision restoration,motor rehabilitation and cognitive enhancement.

Functional near-infrared spectroscopy in non-invasive neuromodulation

Non-invasive cerebral neuromodulation technologies are essential for the reorganization of cerebral neural networks,which have been widely applied in the field of central neurological diseases,such as stroke,Parkinson’s disease,and mental disorders.Although significant advances have been made in neuromodulation technologies,the identification of optimal neurostimulation paramete rs including the co rtical target,duration,and inhibition or excitation pattern is still limited due to the lack of guidance for neural circuits.Moreove r,the neural mechanism unde rlying neuromodulation for improved behavioral performance remains poorly understood.Recently,advancements in neuroimaging have provided insight into neuromodulation techniques.Functional near-infrared spectroscopy,as a novel non-invasive optical brain imaging method,can detect brain activity by measuring cerebral hemodynamics with the advantages of portability,high motion tole rance,and anti-electromagnetic interference.Coupling functional near-infra red spectroscopy with neuromodulation technologies offe rs an opportunity to monitor the cortical response,provide realtime feedbac k,and establish a closed-loop strategy integrating evaluation,feedbac k,and intervention for neurostimulation,which provides a theoretical basis for development of individualized precise neuro rehabilitation.We aimed to summarize the advantages of functional near-infra red spectroscopy and provide an ove rview of the current research on functional near-infrared spectroscopy in transcranial magnetic stimulation,transcranial electrical stimulation,neurofeedback,and braincomputer interfaces.Furthermore,the future perspectives and directions for the application of functional near-infrared spectroscopy in neuromodulation are summarized.In conclusion,functional near-infrared spectroscopy combined with neuromodulation may promote the optimization of central pellral reorganization to achieve better functional recovery form central nervous system diseases.

Prolonged intermittent theta burst stimulation restores the balance between A_(2A)R-and A_(1)R-mediated adenosine signaling in the 6-hydroxidopamine model of Parkinson's disease

An imbalance in adenosine-mediated signaling,particularly the increased A_(2A)R-mediated signaling,plays a role in the pathogenesis of Parkinson's disease.Existing therapeutic approaches fail to alter disease progression,demonstrating the need for novel approaches in PD.Repetitive transcranial magnetic stimulation is a non-invasive approach that has been shown to improve motor and non-motor symptoms of Parkinson's disease.However,the underlying mechanisms of the beneficial effects of repetitive transcranial magnetic stimulation remain unknown.The purpose of this study is to investigate the extent to which the beneficial effects of prolonged intermittent theta burst stimulation in the 6-hydroxydopamine model of experimental parkinsonism are based on modulation of adenosine-mediated signaling.Animals with unilateral 6-hydroxydopamine lesions underwent intermittent theta burst stimulation for 3 weeks and were tested for motor skills using the Rotarod test.Immunoblot,quantitative reverse transcription polymerase chain reaction,immunohistochemistry,and biochemical analysis of components of adenosine-mediated signaling were performed on the synaptosomal fraction of the lesioned caudate putamen.Prolonged intermittent theta burst stimulation improved motor symptoms in 6-hydroxydopamine-lesioned animals.A 6-hydroxydopamine lesion resulted in progressive loss of dopaminergic neurons in the caudate putamen.Treatment with intermittent theta burst stimulation began 7 days after the lesion,coinciding with the onset of motor symptoms.After treatment with prolonged intermittent theta burst stimulation,complete motor recovery was observed.This improvement was accompanied by downregulation of the e N/CD73-A_(2A)R pathway and a return to physiological levels of A_(1)R-adenosine deaminase 1 after 3 weeks of intermittent theta burst stimulation.Our results demonstrated that 6-hydroxydopamine-induced degeneration reduced the expression of A_(1)R and elevated the expression of A_(2A)R.Intermittent theta burst stimulation reversed these effects by restoring the abundances of A_(1)R and A_(2A)R to control levels.The shift in ARs expression likely restored the balance between dopamine-adenosine signaling,ultimately leading to the recovery of motor control.

Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders

Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation （rTMS） is non-invasive and may be an ideal treatment for co-occurring AUD ＋ mTBI ＋ PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD ＋ mTBI ＋ PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.

Low-frequency transcranial magnetic stimulation is beneficial for enhancing synaptic plasticity in the aging brain

In the aging brain, cognitive function gradually dedines and causes a progressive reduction in the structural and functional plasticity of the hippocampus. Transcranial magnetic stimulation is an emerging and novel neurological and psychiatric tool used to investigate the neurobiology of cognitive function. Recent studies have demonstrated that low-frequency transcranial magnetic stimulation （〈1 Hz） ameliorates synaptic plasticity and spatial cognitive deficits in learning-impaired mice. However, the mechanisms by which this treatment improves these deficits during normal aging are still unknown. Therefore, the current study investigated the effects of transcranial magnetic stimulation on the brain-derived neurotrophic factor signal pathway, synaptic protein markers, and spatial memory behavior in the hippocampus of normal aged mice. The study also investigated the downstream regulator, Fyn kinase, and the downstream effectors, synaptophysin and growth-associated protein 43 （both synaptic markers）, to determine the possible mechanisms by which transcranial magnetic stimulation regulates cognitive capacity. Transcranial magnetic stimulation with low intensity （110% average resting motor threshold intensity, 1 Hz） increased mRNA and protein levels of brain-derived neurotrophic factor, tropomyosin receptor kinase B, and Fyn in the hippocampus of aged mice. The treatment also upregulated the mRNA and protein expression of synaptophysin and growth-associated protein 43 in the hippocampus of these mice. In conclusion, brain-derived neurotrophic factor signaling may play an important role in sustaining and regulating structural synaptic plasticity induced by transcranial magnetic stimulation in the hippocampus of aging mice, and Fyn may be critical during this regulation. These responses may change the structural plasticity of the aging hippocampus, thereby improving cognitive function.

Transcranial pulse current stimulation improves the locomotor function in a rat model of stroke

Previous studies have shown that transcranial pulse current stimulation(tPCS) can increase cerebral neural plasticity and improve patients' locomotor function.However, the precise mechanisms underlying this effect remain unclear.In the present study, rat models of stroke established by occlusion of the right cerebral middle artery were subjected to tPCS, 20 minutes per day for 7 successive days.tPCS significantly reduced the Bederson score, increased the foot print area of the affected limbs, and reduced the standing time of affected limbs of rats with stroke compared with that before intervention.Immunofluorescence staining and western blot assay revealed that tPCS significantly increased the expression of microtubule-associated protein-2 and growth-associated protein-43 around the ischemic penumbra.This finding suggests that tPCS can improve the locomotor function of rats with stroke by regulating the expression of microtubule-associated protein-2 and growth-associated protein-43 around the ischemic penumbra.These findings may provide a new method for the clinical treatment of poststroke motor dysfunction and a theoretical basis for clinical application of tPCS.The study was approved by the Animal Use and Management Committee of Shanghai University of Traditional Chinese Medicine of China(approval No.PZSHUTCM190315003) on February 22, 2019.

Delayed improvements in visual memory task performance among chronic schizophrenia patients after high-frequency repetitive transcranial magnetic stimulation

BACKGROUND Cognitive impairments are core characteristics of schizophrenia,but are largely resistant to current treatments.Several recent studies have shown that highfrequency repetitive transcranial magnetic stimulation(rTMS)of the left dorsolateral prefrontal cortex(DLPFC)can reduce negative symptoms and improve certain cognitive deficits in schizophrenia patients.However,results are inconsistent across studies.AIM To examine if high-frequency rTMS of the DLPFC can improve visual memory deficits in patients with schizophrenia.METHODS Forty-seven chronic schizophrenia patients with severe negative symptoms on stable treatment regimens were randomly assigned to receive active rTMS to the DLPFC(n=25)or sham stimulation(n=22)on weekdays for four consecutive weeks.Patients performed the pattern recognition memory(PRM)task from the Cambridge Neuropsychological Test Automated Battery at baseline,at the end of rTMS treatment(week 4),and 4 wk after rTMS treatment(week 8).Clinical symptoms were also measured at these same time points using the Scale for the Assessment of Negative Symptoms(SANS)and the Positive and Negative Syndrome Scale(PANSS).RESULTS There were no significant differences in PRM performance metrics,SANS total score,SANS subscores,PANSS total score,and PANSS subscores between active and sham rTMS groups at the end of the 4-wk treatment period,but PRM performance metrics(percent correct and number correct)and changes in these metrics from baseline were significantly greater in the active rTMS group at week 8 compared to the sham group(all P<0.05).Active rTMS treatment also significantly reduced SANS score at week 8 compared to sham treatment.Moreover,the improvement in visual memory was correlated with the reduction in negative symptoms at week 8.In contrast,there were no between-group differences in PANSS total score and subscale scores at either week 4 or week 8(all P>0.05).CONCLUSION High-frequency transcranial magnetic stimulation improves visual memory and reduces negative symptoms in schizophrenia,but these effects are delayed,potentially due to the requirement for extensive neuroplastic changes within DLPFC networks.

Transcranial direct current stimulation in psychiatric disorders

The interest in non-invasive brain stimulation techniques is increasing in recent years. Among these techniques, transcranial direct current stimulation(t DCS) has been the subject of great interest among researchers because of its easiness to use, low cost, benign profile of side effects and encouraging results of research in the field. This interest has generated several studies and randomized clinical trials, particularly in psychiatry. In this review, we provide a summary of the development of the technique and its mechanism of action as well as a review of the methodological aspects of randomized clinical trials in psychiatry, including studies in affective disorders, schizophrenia, obsessive compulsive disorder, child psychiatry and substance use disorder. Finally,we provide an overview of t DCS use in cognitive enhancement as well as a discussion regarding its clinical use and regulatory and ethical issues. Although many promising results regarding t DCS efficacy were described, the total number of studies is still low, highlighting the need of further studies aiming to replicate these findings in larger samples as to provide a definite picture regarding t DCS efficacy in psychiatry.

Random noise stimulation in the treatment of patients with neurological disorders

Random noise stimulation technique involves applying any form of energy(for instance,light,mechanical,electrical,sound)with unpredictable intensities through time to the brain or sensory receptors to enhance sensory,motor,or cognitive functions.Random noise stimulation initially employed mechanical noise in auditory and cutaneous stimuli,but electrical energies applied to the brain or the skin are becoming more frequent,with a series of clinical applications.Indeed,recent evidence shows that transcranial random noise stimulation can increase corticospinal excitability,improve cognitive/motor performance,and produce beneficial aftereffects at the behavioral and psychological levels.Here,we present a narrative review about the potential uses of random noise stimulation to treat neurological disorders,including attention deficit hyperactivity disorder,schizophrenia,amblyopia,myopia,tinnitus,multiple sclerosis,post-stroke,vestibular-postural disorders,and sensitivity loss.Many of the reviewed studies reveal that the optimal way to deliver random noise stimulation-based therapies is with the concomitant use of neurological and neuropsychological assessments to validate the beneficial aftereffects.In addition,we highlight the requirement of more randomized controlled trials and more physiological studies of random noise stimulation to discover another optimal way to perform the random noise stimulation interventions.

磁共振成像影像导航及靶区选择在经颅磁刺激治疗中的应用

背景:在经颅磁刺激临床实际应用中,是否能准确瞄准刺激脑区可影响经颅磁刺激的实际治疗效果。近年来,随着神经导航系统、移动式增强现实技术的发展,以及多种不同模态磁共振成像数据分析方法的出现,刺激靶区定位的准确性和靶区选择的优化有望得到进一步的提高。目的:综述基于磁共振成像的影像导航定位原理及在经颅磁刺激中的应用,归纳不同模态磁共振成像数据分析在指导经颅磁刺激靶区选择上的作用。方法:应用计算机在PubMed、中国知网和万方数据库检索相关文献,以“transcranial magnetic stimulation,coil positioning,neuronavigation,augmented reality,magnetic resonance imaging,经颅磁刺激,线圈定位,神经导航,增强现实,核磁共振成像,原理”为主要检索词,最终纳入63篇文献进行分析。结果与结论:①传统经颅磁刺激线圈放置方法中,“5 cm规则”、国际脑电10-20定位法最为常用,这些方法具有简便、经济的优点,但过于依赖操作者的经验,存在不同操作者的技术差异。②基于立体定向技术发展而来的神经导航系统是目前可视化程度及准确度最高的辅助经颅磁刺激线圈放置的引导方式,它通过MRI数据采集、脑三维重建、头模配准及立体几何定位等步骤来实现可视化定位,具有较高的临床治疗及科研应用价值,但因其设备较为昂贵,目前在医疗机构中尚未普及。③对于不同层次的医疗单位,移动式移动式增强现实技术不失为一种经济、高效的神经导航系统替代方案,它通过磁共振成像数据采集、构建二维/三维图像、虚拟图像与真实脑图像叠加来实现头皮下脑组织可视化定位,具有直观性强、成本低廉的优势,可在基层医疗单位推广应用。④尽管相对脑电10-20定位策略,可视化定位的临床疗效优越性目前尚未充分体现,但随着研究者对人脑多种不同模态磁共振成像扫描数据的挖掘,有望进一步优化经颅磁刺激治疗靶区选择的策略,提高经颅磁刺激治疗应答率和个性化程度,这在将来是极具潜力和挑战的研究方向。

A preliminary comparison of motor learning across different non-invasive brain stimulation paradigms shows No consistent modulations

BACKGROUND AND OBJECTIVE Non-invasive brain stimulation ( NIBS) has been widely explored as a way to safely modulate brain activity and alter human performance for nearly three decades. Research using NIBS has grown exponentially within the last decade with promising results across a variety of clinical and healthy populations. However, recent work has shown high inter-individual variability and a lack of reproducibility of previous results. Here, we conducted a small preliminary study to explore the effects of three of the most commonly used excitatory NIBS paradigms over the primary motor cortex (Ml) on motor learning ( Sequential Visuomotor Isometric Pinch Force Tracking Task) and secondarily relate changes in motor learning to changes in cortical excitability ( MEP amplitude and SICI).

Progress in neurorehabilitation research and the support by the National Natural Science Foundation of China from 2010 to 2022

The National Natural Science Foundation of China is one of the major funding agencies for neuro rehabilitation research in China.This study reviews the frontier directions and achievements in the field of neurorehabilitation in China and wo rldwide.We used data from the Web of Science Core Collection(WoSCC) database to analyze the publications and data provided by the National Natural Science Foundation of China to analyze funding information.In addition,the prospects for neurorehabilitation research in China are discussed.From 2010 to 2022,a total of 74,220 publications in neurorehabilitation were identified,with there being an overall upward tendency.During this period,the National Natural Science Foundation of China has funded 476 research projects with a total funding of 192.38 million RMB to support neuro rehabilitation research in China.With the support of the National Natural Science Foundation of China,China has made some achievements in neurorehabilitation research.Research related to neurorehabilitation is believed to be making steady and significant progress in China.

Targeting epigenetic mechanisms in amyloid-β-mediated Alzheimer’s pathophysiology:unveiling therapeutic potential

Alzheimer’s disease is a prominent chronic neurodegenerative condition characterized by a gradual decline in memory leading to dementia.Growing evidence suggests that Alzheimer’s disease is associated with accumulating various amyloid-βoligomers in the brain,influenced by complex genetic and environmental factors.The memory and cognitive deficits observed during the prodromal and mild cognitive impairment phases of Alzheimer’s disease are believed to primarily result from synaptic dysfunction.Throughout life,environmental factors can lead to enduring changes in gene expression and the emergence of brain disorders.These changes,known as epigenetic modifications,also play a crucial role in regulating the formation of synapses and their adaptability in response to neuronal activity.In this context,we highlight recent advances in understanding the roles played by key components of the epigenetic machinery,specifically DNA methylation,histone modification,and microRNAs,in the development of Alzheimer’s disease,synaptic function,and activity-dependent synaptic plasticity.Moreover,we explore various strategies,including enriched environments,exposure to non-invasive brain stimulation,and the use of pharmacological agents,aimed at improving synaptic function and enhancing long-term potentiation,a process integral to epigenetic mechanisms.Lastly,we deliberate on the development of effective epigenetic agents and safe therapeutic approaches for managing Alzheimer’s disease.We suggest that addressing Alzheimer’s disease may require distinct tailored epigenetic drugs targeting different disease stages or pathways rather than relying on a single drug.

经颅微电流刺激对剖宫产术产妇产后抑郁的影响

目的探讨经颅微电流刺激对剖宫产术产妇产后抑郁评分的影响。方法选择2021年3—6月于徐州医科大学附属医院行选择性剖宫产术产妇120例,采用随机数字表法分为干预组与对照组,各60例。腰椎-硬膜外联合麻醉完成后,干预组行经颅微电流刺激20 min;对照组实施同等时间的假刺激。在产妇入手术室前(T0)、入手术室后(T1)、出手术室前(T2)及术后24 h(T3)进行爱丁堡产后抑郁量表评分。统计术后24 h(T3)行产妇疲劳量表、视觉模拟(VAS)量表、产后满意度量表评分及产后并发症发生率。结果两组术前基线水平与术中情况相比差异无统计学意义。与对照组相比,刺激前两组抑郁评分差异无统计学意义(P>0.05),刺激完成后干预组抑郁评分低于对照组[T2(8.58±3.70)分比(10.49±3.82)分,T3(7.27±4.05)分比(9.85±2.68)分,均P<0.05]。干预组术后VAS评分低于对照组[4(3.00,6.00)分比6(4.00,7.00)分,P<0.05],但术后疲劳评分、术后满意度评分及两组术后并发症发生率相比差异无统计学意义(P>0.05)。结论经颅微电流刺激对改善腰硬联合麻醉行剖宫产术产妇产后抑郁水平有积极作用。希望对产妇抑郁的治疗策略提供证据。

立体定向下核团毁损术及脑深部电刺激术治疗难治性强迫症

目的探讨MRI定位下核团毁损术及脑深部电刺激术治疗难治性强迫症的疗效。方法应用MRI定位下射频热凝核团毁损术及脑深部电刺激术治疗难治性强迫症49例,其中30例行双侧内囊前肢毁损术,13例行双侧扣带回加双侧内囊前肢毁损术,6例行右侧伏隔核脑深部电刺激术加对侧内囊前肢毁损术。手术前后应用YALE-BROWN强迫症状量表、汉密尔顿抑郁量表、汉密尔顿焦虑量表对手术效果进行评价。结果术后6个月均获随访,其中临床痊愈28例,显著改善9例,轻度改善7例,无明显变化5例。22例术后早期出现一过性并发症,均在术后2周内恢复。术后焦虑,强迫,抑郁症状量表分数均明显下降(P<0.01)。结论MRI定位下核团毁损术及脑深部电刺激术治疗难治性强迫症有显著疗效,并发症较轻,可以显著改善病人强迫、焦虑、抑郁症状。

ROSA辅助脑深部电刺激术的精准性研究

目的探讨立体定向手术机器人(Robot of Stereotactic Assistant,ROSA)辅助下脑深部电刺激术(DBS)准确性及安全性。方法 18例帕金森病和2例特发性震颤病人,均行ROSA辅助下DBS,术后复查CT,记录电极在x轴和y轴最大偏差距离和最小偏差距离,计算平均值。记录术中电极相关出血事件与术后并发症。结果 20例病人术前计划植入电极39根,实际植入电极39根,其中植入丘脑底核37根,丘脑腹中间核2根。电极尖端距靶点x轴最大偏差距离2.13 mm,最小偏差距离0.09 mm,平均偏差距离(0.68±0.43)mm;y轴最大偏差距离1.50 mm,最小偏差距离0.21 mm,平均偏差距离(0.63±0.29)mm。结论 ROSA辅助下行DBS,电极植入准确,安全性高。

旋律音调疗法与非侵入性脑刺激技术在卒中后失语中的研究进展

卒中后语言功能恢复的神经机制仍不明确,目前认为左侧大面积脑损伤的失语患者语言功能恢复主要通过激活右侧半球的同源脑区进而改善言语功能。旋律音调疗法(MIT)可以通过旋律音调和左手拍击激活右侧半球的额颞叶脑区,特别适用于左侧大面积脑损伤的非流利性失语患者的语言康复。非侵入性脑刺激技术(NBS)通过刺激病灶侧或病灶对侧改变脑电活动,已被用于促进卒中后语言功能恢复。兴奋性经颅刺激作用于右侧半球同源性语言功能区联合MIT可一定程度上促进左侧大面积脑损伤的卒中后严重失语患者的语言恢复。未来可尝试将传统的言语治疗联合MIT及外部的经颅刺激(包括经颅直流电刺激及经颅磁刺激)促进语言相关功能区域的激活,从而更大限度地改善脑卒中患者言语功能。

颅内电极置入与脑功能区定位技术在功能区难治性癫疒间手术的应用

目的探讨颅内电极埋藏与脑功能区定位技术在功能区起始的难治性癫疒间手术的评估价值。方法回顾性分析7例难治性癫疒间的临床资料,头皮视频脑电图长程监测均考虑致疒间灶可能累及功能区,故行颅内电极置入术,再行皮质电极视频脑电图长程监测,记录发作间期和发作期脑电图,以判断致疒间皮质,并采用皮质电刺激行脑功能区定位,在指导术中尽可能切除致疒间皮质的同时,最大限度保护脑功能。结果癫疒间发作起始区切除2例,癫疒间起始区部分切除加周围皮质热灼5例。随访6个月~1年,术后运动及语言功能均保护良好6例,对侧肢体出现短暂运动障碍后恢复1例。结论颅内电极埋藏与脑功能区定位技术是功能区难治性癫疒间手术必要评估手段,有助于术前明确脑功能区和皮质放电区域,以及两者之间的关系,指导设计手术方式,最大限度提高病人术后生活质量。

成人型肌张力障碍的手术治疗(附16例分析)

目的探讨立体定向核团毁损手术及脑深部电刺激手术治疗成人型肌张力障碍的疗效。方法将16例成人型肌张力障碍病人按受累部位分成3组:A组:书写痉挛,12例;B组:节段性肌张力障碍,3例,A、B组采用立体定向核团毁损手术治疗;C组:痉挛性斜颈,1例,采用脑深部电刺激手术治疗,并根据颈部痉挛肌群肌电活动强度,进行脑深部电刺激参数的调整。随访1年,观察运动功能改善情况。结果A组均治愈;B组平均改善率59.7%;C组在肌电监测之前,临床改善率为23.1%,根据肌电活动强度调整双侧脑深部电极刺激参数后临床改善率为67.3%。结论立体定向丘脑腹外侧核毁损手术是治疗书写痉挛的有效手段。肌电活动强度是设定和调整脑深部电刺激参数的量化指标,可以缩短反复调整的时间,减少电池耗费。