Surgical Interventions for Task-specific Dystonia (Writer's Dystonia).
Surgical Interventions for Task-specific Dystonia (Writer's Dystonia).
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DOI：
10.4103/aian.aian_15_17
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发表时间：
2017-07
影响因子：
1.7
通讯作者：
Kadlas DB
中科院分区：
文献类型：
--
作者：
Doshi PK;Ramdasi RV;Karkera B;Kadlas DB
书写痉挛是一种局灶性肌张力障碍，在选择性运动活动中产生异常姿势。丘脑切开术或苍白球内深部脑刺激（GPi DBS）已被用作对药物治疗无反应的患者的手术治疗。8例难治性局灶性手肌张力障碍患者（均为男性，年龄16-47岁）使用立体定向技术接受了腹口侧（Vo）丘脑切开术（7例患者）或GPi DBS（1例患者）。在基线和最后1 - 4年随访时评价术前视频记录、肌张力障碍姿势和肌张力障碍潜伏期的书写运动评分（WMS）和症状严重程度评分（SSS）。所有患者都难以完成最常见的任务。症状持续时间从6个月到12年不等。所有患者术后肌张力障碍症状均得到立即缓解，并且在随访期间效果持续。WMS（范围0-28）从术前的平均14.5改善至2，而SSS（最大值43和最小值10）从术前的平均15.3改善至末次随访时的2。无手术并发症、发病率或死亡率。Vo丘脑切开术或GPi DBS可成功缓解任务特异性肌张力障碍患者的症状。
Writer's cramp is a focal dystonia producing abnormal postures during selective motor activities. Thalamotomy or globus pallidus internus deep brain stimulation (GPi DBS) has been used as a surgical treatment in patients not responding to medical treatment. Eight patients (all men, age 16–47 years) with refractory focal hand dystonia underwent either ventrooralis (Vo) thalamotomy (seven patients) or GPi DBS (one patient) using stereotactic techniques. Preoperative video recordings, Writing movment score for dystonic posture and latency of dystonia (WMS), and symptom severity scores (SSSs) were evaluated at baseline and latest follow-up ranging from 1 to 4 years. All patients had difficulty in performing their most common tasks. The duration of symptoms ranged from 6 months to 12 years. All patients obtained immediate postoperative relief from the dystonic symptoms, and the effect was sustained during the follow-up period. The WMS (range 0–28) improved from a mean of 14.5 before surgery to 2, whereas the SSS (maximum 43 and minimum 10) improved from a mean of 15.3 before surgery to 2 at the last follow-up. There were no surgical complications, morbidity, or mortality. Vo thalamotomy or GPi DBS offers successful symptom relief in patients with task-specific dystonia.