Brain Stimulation for Torsion Dystonia.
Brain Stimulation for Torsion Dystonia.
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DOI：
10.1001/jamaneurol.2015.51
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发表时间：
2015-06
期刊：
影响因子：
29
通讯作者：
Alterman RL
中科院分区：
文献类型：
--
作者：
Fox MD;Alterman RL
肌张力障碍是一种以异常肌肉收缩为特征的异质性神经疾病，标准的药物治疗往往不足以应对这种异常肌肉收缩。对于这样的患者，治疗性脑刺激正变得越来越多地被使用。在这里，我们回顾了用不同类型的脑刺激治疗不同类型的肌张力障碍的证据和效果大小。强有力的(B级)证据支持使用脑深部刺激(DBS)治疗原发性全身性或节段性肌张力障碍，特别是Dyt-1，以及颈肌张力障碍患者。据报道，DBS治疗迟发性肌张力障碍、作家痉挛、颅骨肌张力障碍、肌阵挛障碍以及与帕金森病相关的非状态肌张力障碍的疗效也很大。较小的益处通常见于继发于结构性脑损伤的肌张力障碍。其他脑刺激技术包括硬膜外皮质刺激和非侵入性脑刺激也被研究过，但通常报告在更有限数量的患者中效果较小。有关患者选择，手术方法，DBS编程，和作用机制的最新进展进行了讨论。
Dystonia is a heterogeneous neurological disorder characterized by abnormal muscle contractions for which standard medical therapy is often inadequate. For such patients, therapeutic brain stimulation is becoming increasingly utilized. Here we review the evidence and effect sizes for treating different types of dystonia with different types of brain stimulation. Strong (level B) evidence supports the use of deep brain stimulation (DBS) for the treatment of primary generalized or segmental dystonia, especially DYT-1, as well as for patients with cervical dystonia. Large effect sizes have also been reported for DBS treatment of tardive dystonia, writer’s cramp, cranial dystonia, myoclonus dystonia, and off-state dystonia associated with Parkinson’s disease. Lesser benefit is generally seen in dystonia secondary to structural brain damage. Other brain stimulation techniques including epidural cortical stimulation and noninvasive brain stimulation have been investigated, but generally report smaller effect sizes in a more limited number of patients. Recent advances relevant to patient selection, surgical approach, DBS programming, and mechanism of action are discussed.