Pallidothalamic Tractotomy (Forel's Field H1-tomy) for Dystonia: Preliminary Results
Pallidothalamic Tractotomy (Forel's Field H1-tomy) for Dystonia: Preliminary Results
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DOI：
10.1016/j.wneu.2019.06.055
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发表时间：
2019-09-01
影响因子：
2
通讯作者：
Taira, Takaomi
中科院分区：
文献类型：
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作者：
Horisawa, Shiro;Fukui, Atsushi;Taira, Takaomi
目的：苍白球内侧束与丘脑腹前部和腹外侧部相连。损毁或刺激苍白球丘脑束对帕金森病患者的运动障碍和肌张力障碍有改善作用。方法：我们对2017年7月至2018年10月在东京女子医科大学医院接受单侧苍白丘脑束切开术的肌张力障碍患者进行了回顾性分析。采用Burke-Fahn-Marsden肌张力障碍评定量表-运动评定量表在3个时间点(术前、术后3个月、最后一次随访)评定肌张力障碍的严重程度。结果：11例单侧苍白丘脑束切开术，其中5例为全身性肌张力障碍，4例为节段性肌张力障碍，2例为局限性(颈部)肌张力障碍。所有患者均在对侧苍白球束切开术前行一侧苍白球切开术。前次手术(苍白球切开术)和苍白球束切开术之间的平均间隔为9.5+/-3.1个月。平均随访时间为11.5+/-4.2个月。术后3个月Burke-Fahn-Marsden Dystonia运动评定量表评分(5.8±-8.4)和末次随访时评分(5.6+/-8.3，P<；0.001)较术前(2 1.8+/-16.3)明显改善。最常见的不良反应是发音量降低(6例)，音量较轻，不影响患者的日常活动。结论：本研究提示苍白丘脑束切开术可作为肌张力障碍的替代治疗靶点。需要一项更大更长的前瞻性研究来阐明苍白丘脑束切开术治疗肌张力障碍的安全性和有效性。
OBJECTIVES: The pallidothalamic tract connects the globus pallidus internus with the ventroanterior and ventrolateral parts of the thalamus. Lesioning or stimulation of the pallidothalamic tract has ameliorating effects on dyskinesia and dystonia in patients with Parkinson disease. However, the effect of the procedure on dystonia due to other etiologies has not been reported.METHODS: We retrospectively analyzed patients with dystonia who underwent unilateral pallidothalamic tractotomy between July 2017 and October 2018 at Tokyo Women's Medical University Hospital. The Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale was used to evaluate the severity of dystonia at three time points (before surgery, 3 months postoperatively, and the last available follow-up). Adverse events were also evaluated.RESULTS: Eleven patients underwent unilateral pallidothalamic tractotomy, including 5 with generalized dystonia, 4 with segmental dystonia, and 2 with focal (cervical) dystonia. All patients had undergone unilateral pallidotomy before contralateral pallidothalamic tractotomy. The mean interval between the previous surgery (pallidotomy) and pallidothalamic tractotomy was 9.5 +/- 3.1 months. The mean follow-up period was 11.5 +/- 4.2 months. The Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale scores at 3 months after pallidothalamic tractotomy (5.8 +/- 8.4) and at the last available follow-up (5.6 +/- 8.3, P < 0.001) were significantly improved compared with that before pallidothalamic tractotomy (21.8 +/- 16.3). The most common adverse event was reduced voice volume (6 patients), which was mild and did not interfere with the patient's daily activities.CONCLUSIONS: This study suggests that pallidothalamic tractotomy can be an alternative treatment target for dystonia. A larger and longer prospective study is needed to elucidate the safety and efficacy of pallidothalamic tractotomy for dystonia.