Thalamic deep brain stimulation for writer's cramp
Thalamic deep brain stimulation for writer's cramp
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DOI：
10.3171/jns-07/11/0977
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发表时间：
2007-11-01
影响因子：
4.1
通讯作者：
Yamamoto, Takamitsu
中科院分区：
文献类型：
--
作者：
Fukaya, Chikashi;Katayama, Yoichi;Yamamoto, Takamitsu
对象。作家痉挛是一种特发性局灶性手肌张力障碍，其特征是在执行写作任务时出现肌肉痉挛。在本报告中，作者描述了丘脑深部脑刺激（DBS）治疗作家痉挛患者的临床结果，并提出了一个说明性病例，他们比较了苍白部和丘脑刺激的效果。除了这些临床效果的结果外，他们还研究了运动丘脑的治疗刺激的最佳点和模式，包括腹侧核（VO）和腹侧中间核（VIM），以治疗作家痉挛。作者将丘脑DBS应用于5例作家痉挛患者。在这种疾病中，DBS试验的纳入标准是特发性作家痉挛的诊断和对药物缺乏积极反应。排除标准包括明显的认知功能障碍，活跃的精神症状，以及其他中枢神经系统疾病或其他医学障碍的证据。其中1例将DBS导联同时植入苍白球和VO/VIM，并进行1周的测试刺激。因此，作者有机会比较在这个病人身上进行白质和丘脑刺激的效果。在丘脑刺激开始后，与作家痉挛相关的神经功能缺陷在所有5例中立即得到改善。术后所有术前量表评分显示作家痉挛的严重程度显著降低（p < 0.001）。在植入2枚DBS导联的患者中，丘脑刺激的临床效果优于苍白部刺激。在丘脑刺激过程中，与仅在丘脑内刺激相比，广泛地同时刺激左脑和中皮层时效果最大。作者成功地用丘脑DBS治疗了作家痉挛患者。据他们所知，这是第一个用DBS治疗作家痉挛的系列。丘脑刺激似乎是一种安全而有价值的治疗选择。
Object. Writer's cramp is a type of idiopathic focal hand dystonia characterized by muscle cramps that accompany execution of the writing task specifically. In this report, the authors describe the clinical outcome after thalamic deep brain stimulation (DBS) therapy in patients with writer's cramp and present an illustrative case with which they compare the effects of pallidal and thalamic stimulation. In addition to these results for the clinical effectiveness, they also examine the best point and pattern for therapeutic stimulation of the motor thalamus, including the nucleus ventrooralis (VO) and the ventralis intermedius nucleus (VIM), for writer's cramp.Methods. The authors applied thalamic DBS in five patients with writer's cramp. The inclusion criteria for the DBS trial in this disorder were a diagnosis of idiopathic writer's cramp and the absence of a positive response to medication. The exclusion criteria included significant cognitive dysfunction, active psychiatric symptoms, and evidence of other central nervous system diseases or other medical disorders. In one of the cases, DBS leads were implanted into both the globus pallidus interinus and the VO/VIM, and test stimulation was performed for 1 week. The authors thus had an opportunity to compare the effects of pallidal and thalamic stimulation in this patient.Results. Immediately after the initiation of thalamic stimulation, the neurological deficits associated with writer's cramp were improved in all five cases. Postoperatively all preoperative scale scores indicating the seriousness of the writer's cramp were significantly lower (p < 0.001). In the patient in whom two DBS leads were implanted, the clinical effect of thalamic stimulation was better than that of pallidal stimulation. During the thalamic stimulation, the maximum effect was obtained when stimulation was applied to both the VO and the VIM widely, compared with being applied only within the VO.Conclusions. The authors successfully treated patients with writer's cramp by thalamic DBS. Insofar as they are aware, this is the first series in which writer's cramp has been treated with DBS. Thalamic stimulation appears to be a safe and valuable therapeutic option for writer's cramp.