Neurosurgical management of elevated tone in childhood: interventions, indications and uncertainties.
Neurosurgical management of elevated tone in childhood: interventions, indications and uncertainties.
复制标题
儿童期音调升高的神经外科治疗：干预措施、适应症和不确定性。
DOI：
10.1136/archdischild-2020-320907
复制
发表时间：
2023
影响因子：
5.2
通讯作者：
Lumsden DE
中科院分区：
文献类型：
--
作者：
Lumsden DE
音调升高（张力亢进）是身体残疾儿童的常见问题。旨在降低张力的药物通常疗效有限，而且其使用还受到显着副作用的限制。因此，人们对姿势和语气管理神经外科干预措施 (NIMPT) 的应用越来越感兴趣。现在常用的三种主要手术是：选择性背神经根切断术（SDR）、鞘内巴氯芬（ITB）和深部脑刺激（DBS）。本综述比较了这些干预措施，并讨论了病变手术的潜在作用。这些干预措施针对痉挛和肌张力障碍各不相同，作用于分布式运动网络的不同点。 SDR 是一种减少痉挛的干预措施，最广泛用于精心挑选的可行走的脑瘫儿童。 ITB 更常用于患有更严重残疾（通常无法行走）的儿童，并且可以改善肌张力障碍和痉挛。 DBS 是一种可以改善肌张力障碍的干预措施。对于患有某些遗传性肌张力障碍的儿童，深部脑刺激可能会显着改善肌张力障碍。对于肌张力障碍的其他原因，特别是由于后天性脑损伤引起的肌张力障碍，手术后的改善更为温和且可变。这三种干预措施的副作用和可逆性各不相同。目前，有些儿童群体尚不清楚应考虑采取哪种干预措施（SDR 与 ITB，或 ITB 与 DBS）。人们对英国各地儿童获得 NIMPT 的公平性以及每年进行的手术数量是否满足临床需求提出了担忧。
Elevated tone (hypertonia) is a common problem in children with physical disabilities. Medications intended to reduce tone often have limited efficacy, with use further limited by a significant side effect profile. Consequently, there has been growing interest in the application of Neurosurgical Interventions for the Management of Posture and Tone (NIMPTs). Three main procedures are now commonly used: selective dorsal rhizotomy (SDR), intrathecal baclofen (ITB) and deep brain stimulation (DBS). This review compares these interventions, along with discussion on the potential role of lesioning surgery. These interventions variably target spasticity and dystonia, acting at different points in the distributed motor network. SDR, an intervention for reducing spasticity, is most widely used in carefully selected ambulant children with cerebral palsy. ITB is more commonly used for children with more severe disability, typically non-ambulant, and can improve both dystonia and spasticity. DBS is an intervention which may improve dystonia. In children with certain forms of genetic dystonia DBS may dramatically improve dystonia. For other causes of dystonia, and in particular dystonia due to acquired brain injury, improvements following surgery are more modest and variable. These three interventions vary in terms of their side-effect profile and reversibility. There are currently populations of children for who it is unclear which intervention should be considered (SDR vs ITB, or ITB vs DBS). Concerns have been raised as to the equity of access to NIMPTs for children across the UK, and whether the number of surgeries performed each year meets the clinical need.