丘脑底核电刺激治疗继发性肌张力障碍

目的 探讨丘脑底核（STN）的脑深部电剌激（DBS）治疗继发性肌张力障碍的可行性、适应证和并发症。方法 5例行双侧STN—DBS，1例行单侧STN—DBS。结果 术中利用微电极记录的电信号获得STN的准确靶点定位，电刺激后患者肌张力有不同程度下降，但扭转改善不明显。随访半年至3年，6例患者中，药物引起的迟发性肌张力障碍及外伤性肌张力障碍的患者疗效理想，BFMDRS评分改善均在90％以上，且随着随访时间的延长，效果持续不断改善；其余4例患者疗效不佳，4例均肌张力略有改善，其中1例扭转略改善，1例语言及步态略有改善。手术后患者均无明显合并症，但1例术后16个月发现左侧电极折断，后取出。结论 DBS治疗迟发性和外伤性继发性肌张力障碍效果理想，而对于缺氧或脑基底节区弥漫性损害的继发性肌张力障碍效果不佳；STN可以成为治疗本病的理想靶点；术中应根据电生理记录结果和肌张力的轻度改善作为靶点定位的指标；手术无明显合并症。

Subthalamic deep brain stimulation in the treatment of secondary dystonia

Objective To explore the feasibility, indications and complications of STN-DBS in the treatment of secondary dystonia. Methods Five patients underwent bilateral STN-DBS, one underwent unilateral STN-DBS. Results With the help of intraoperative microelectrode recording, STN was accurately localized. Tentative stimulation could decrease muscle tension to a different extent, but twisting had no obvious improvement. Follow-up period was 6 months to 3 years. Among the 6 patients, 2 including the tardive dystonia and traumatic dystonia patients had a perfect outcome, BFMS decreased more than 90%. The symptoms improvement was progressive along with the time passed. The other 4 patients did not improve well. All of them had a mild relaxation in muscle tension. One had twisting improvement. One had improvement in speech and gait. None of them had severe surgery related complications. One had lead fracture 16 months after surgery and the lead was then evacuated. Conclusions DBS could be an ideal treatment for patients of tardive and traumatic dystonia. For patients of anoxia and diffuse impairment in basal ganglia, DBS is not a good choice. STN could be an ideal target, lntraoperative microelectrode recording and mild amelioration of muscle tension are indicators of correct target location. No severe complications exist.