Deep brain stimulation in post-traumatic dystonia: A case series study
Deep brain stimulation in post-traumatic dystonia: A case series study
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深部脑刺激治疗创伤后肌张力障碍：病例系列研究
DOI：
10.1111/cns.13145
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
DianYou Li
中科院分区：
文献类型：
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作者：
HongXia Li;Lu He;ChenCheng Zhang;Robert Eisinger;YiXin Pan;Tao Wang;BoMin Sun;YiWen Wu;DianYou Li
目的深部脑刺激（DBS）已被提议作为药物不耐受的孤立性肌张力障碍的有效治疗方法，但它是否对创伤后肌张力障碍（PTD）也有效尚不清楚。关于 DBS 对 PTD 治疗的疗效，报告数量很少，并且得出了有争议的结论。在此，我们报告了 5 名 PTD 患者在 DBS 治疗后临床获益改善的病例系列。方法 5 名患有致残性 PTD 的患者接受了 DBS 治疗。在基线和最后一次随访（超过 12 个月）时使用 Burke-Fahn-Marsden 肌张力障碍评定量表 (BFMDRS) 评估临床结果。结果 1 号和 3 号患者接受单侧苍白球内部 (GPi) DBS 治疗对侧肌张力障碍。由于病变位于苍白球，因此选择丘脑底核 (STN) 作为患者 2 和 4 的目标。 5 号患者的腹侧中间核 (VIM) 中植入了电极，用于治疗左上肢的主要震颤，局灶性手肌张力障碍得到了意想不到的改善。末次随访时，所有 5 名患者的 BFMDRS 运动评分均显示出良好的改善，范围为 52.4% 至 78.6%。 结论 深部脑刺激可能是治疗难治性 PTD 的有效且安全的治疗方法，但这需要进一步研究证实。
AimsDeep brain stimulation (DBS) has been proposed as an effective treatment for drug‐intolerant isolated dystonia, but whether it is also efficacious for posttraumatic dystonia (PTD) is unknown. Reports are few in number and have reached controversial conclusions regarding the efficacy of DBS for PTD treatment. Here, we report a case series of five PTD patients with improved clinical benefit following DBS treatment.MethodsFive patients with disabling PTD underwent DBS therapy. The clinical outcomes were assessed with the Burke–Fahn–Marsden dystonia rating scale (BFMDRS) at baseline and the last follow‐up visit (at more than 12 months).ResultsPatients 1 and 3 received unilateral globus pallidus internus (GPi) DBS for contralateral dystonia. The subthalamic nucleus (STN) was chosen as target for patients 2 and 4, due to a lesion located in the globus pallidus. Patient 5 had an electrode in the ventral intermediate nucleus (VIM) for treating predominant tremor of left upper extremity, with unexpected improvement of focal hand dystonia. The scores of BFMDRS movement exhibited favorable improvement in all five patients at the last follow‐up, ranging from 52.4% to 78.6%.ConclusionsDeep brain stimulation may be an effective and safe treatment for medically refractory PTD, but this needs to be confirmed by further studies.