Improvement of Post-hypoxic Myoclonus with Bilateral Pallidal Deep Brain Stimulation: A Case Report and Review of the Literature.
Improvement of Post-hypoxic Myoclonus with Bilateral Pallidal Deep Brain Stimulation: A Case Report and Review of the Literature.
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DOI：
10.7916/d8nz8dxp
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Kopell BH
中科院分区：
文献类型：
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作者：
Ramdhani RA;Frucht SJ;Kopell BH
缺氧后肌阵挛（PHM）是当患者遭受缺氧性脑损伤时发生的综合征。肌阵挛通常是多灶性和全身性的，通常起源于皮质和皮质下。在严重的情况下，抗癫痫药物的药物治疗可能无法令人满意地控制肌阵挛。我们报告了一例23岁男性患者，在与哮喘发作相关的心肺骤停后出现慢性药物难治性PHM，经双侧苍白球内（GPi）脑深部电刺激（DBS）治疗后好转。我们回顾了PHM的临床特征，以及该患者的术前和术后统一肌阵挛评定量表评分和DBS程控参数，并将其与文献中其他三例已发表的PHM-DBS病例进行了比较。该患者静息时肌阵挛痉挛缓解，活动性肌阵挛减少39%，双侧GPi-DBS的阳性和阴性肌阵挛均得到改善。治疗反应需要振幅>2.5 V的高频刺激（130 Hz）。我们证明了一个强大的改善药物难治性PHM患者与双边GPi-DBS，并建议这是一个可行的治疗选择衰弱缺氧后肌阵挛。
Post-hypoxic myoclonus (PHM) is a syndrome that occurs when a patient has suffered hypoxic brain injury. The myoclonus is usually multifocal and generalized, often stemming from both cortical and subcortical origins. In severe cases, pharmacological treatments with antiepileptic medications may not satisfactorily control the myoclonus. We present a case of a 23-year-old male with chronic medication refractory PHM following a cardiopulmonary arrest related to an asthmatic attack who improved with bilateral globus pallidus internus (GPi) deep brain stimulation (DBS). We review the clinical features of PHM, as well as the preoperative and postoperative Unified Myoclonus Rating Scale scores and DBS programming parameters in this patient and compare them with the three other published PHM-DBS cases in the literature. This patient experienced an alleviation of myoclonic jerks at rest and a 39% reduction in action myoclonus with improvement in both positive and negative myoclonus with bilateral GPi-DBS. High frequency stimulation (130 Hz) with amplitudes >2.5 V were needed for the therapeutic response. We demonstrate a robust improvement in a medication refractory PHM patient with bilateral GPi-DBS, and suggest that it is a viable therapeutic option for debilitating post-hypoxic myoclonus.