Deep brain stimulation in dystonia
Deep brain stimulation in dystonia
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DOI：
10.1007/s00415-003-1110-2
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发表时间：
2003-02-01
影响因子：
6
通讯作者：
Trottenberg, T
中科院分区：
文献类型：
--
作者：
Kupsch, A;Kuehn, A;Trottenberg, T
20世纪90年代，在帕金森病和原发性震颤中引入脑深部电刺激（DBS）后，对肌张力障碍的立体定向术重新产生了兴趣。DBS从消融手术演变而来，消融手术在20世纪50年代应用于帕金森病、原发性震颤和肌张力障碍等运动障碍患者，结果各不相同。本综述总结了DBS治疗肌张力障碍的临床方面的现有知识（2002年12月）。在携带DYT 1基因突变的肌张力障碍患者中取得了极好的结果，改善高达90%。在特发性全身性肌张力障碍、肌阵挛-肌张力障碍综合征和迟发性肌张力障碍患者中也可获得类似结果。在局灶性肌张力障碍（例如颈部肌张力障碍）患者中观察到了实质性改善。继发性肌张力障碍的患者通常表现出较小的改善程度和更多的变化。长期的研究是必要的，以评估运动和神经心理后遗症DBS肌张力障碍。此外，不同的肌张力障碍疾病的最佳目标仍有待确定，虽然苍白球内目前已成为最有前途的目标肌张力障碍。
Renewed interest in stereotaxy for dystonia followed the introduction of deep brain stimulation (DBS) in Parkinson's disease and essential tremor in the 1990s. DBS evolved from ablative surgery, which was applied with varying results in the 1950s in patients with movement disorders such as Parkinson's disease, essential tremor and dystonia. The present review summarizes the current knowledge on clinical aspects of DBS in dystonia (Dec. 2002). Excellent results have been achieved in dystonic patients carrying a mutation in the DYT1 gene with improvements up to 90%. Similar results may also be obtained in patients with idiopathic generalized dystonia, myoclonus-dystonia syndrome, and tardive dystonia. Substantial improvement has been observed in patients with focal dystonia (for instance cervical dystonia). Patients with secondary dystonia often display a lesser and more variable degree of improvement. Long-term studies are warranted to assess both motor and neuropsychological sequelae of DBS in dystonia. Furthermore, the optimal target for different dystonic disorders remains to be determined, although the globus pallidus internus has currently emerged as the most promising target for dystonia.