脑深部电刺激术治疗扭转痉挛及术后神经调控  

Deep brain stimulation and neuromodulation for torsion dystonia

作　　者：王景[1] 汪鑫[1] 罗甜[1] 李楠[1] 王学廉[1] 高国栋[1] 

机构地区：[1]第四军医大学唐都医院神经外科,西安710038

出　　处：《中国现代神经疾病杂志》2015年第10期800-803,共4页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨脑深部电刺激术治疗扭转痉挛的有效性和安全性，以规范刺激参数调试方案。方法分别采用丘脑底核电刺激术（10例）和苍白球内侧部电刺激术（3例）治疗13例原发性扭转痉挛患者，并进行刺激参数调试，Burke—Fahn—Marsden肌张力障碍量表评价扭转痉挛改善情况，记录手术相关并发症。结果6例于开启刺激器后1～3d、3例于1周后扭转痉挛症状改善率〉60％，6个月后改善率〉75％，1年后〉85％；2例于开启刺激器后2个月出现扭转痉挛症状改善，6个月后改善率〉60％，1年后〉80％；1例于开启刺激器后出现扭转痉挛症状轻微改善，6个月后改善率为45％，1年后为75％。无一例发生手术相关不良反应。行双侧丘脑底核电刺激术者开启刺激器后6个月刺激参数为电压1．50～2．00V，频率130～145Hz，脉宽60～90μs；1年时刺激参数为电压2．00-2．50V，频率130—150Hz，脉宽60．90μs。行双侧苍白球内侧部电刺激术者开启刺激器后6个月刺激参数为电压2．50—2．80V，频率130～160Hz，脉宽60。90灿s；1年时刺激参数为电压2．50～4．00V，频率145～170Hz，脉宽60—90¨s。结论丘脑底核电刺激术和苍白球内侧部电刺激术均可有效改善扭转痉挛症状且安全性良好，刺激参数调试应选择个体化程控参数。Objective To discuss the curative effect and safety of deep brain stimulation （DBS） and neuromodulation in the treatment of patients with torsion dystonia. Methods Ten patients with torsion dystonia underwent subthalamic nucleus DBS （STN- DBS） and 3 patients with torsion dystonia underwent globus pallidus internus DBS （GPi- DBS）. Regulate the stimulus parameters, evaluate the improvement of torsion dystonia by using Burke-Fahn-Marsden Dystonia Rating Scale （BFMDRS） and record related adverse events. Results Among the 13 patients, 6 patients were improved by over 60% in 1-3 d and 3 patients one week after stimulation, and the improvement rate was 〉 75% in 6 months and 〉 85% in one year. Two patients showed improvement 2 months after stimulation, and the improvement rate was 〉 60% in 6 months and 〉 80% in one year. One patient showed slight improvement immediately after operation, and the improvement rate increased to 45% in 6 months and 75% in one year. One patient removed the stimulator. No adverse event related to the operation was found in all 13 patients. The stimulus parameters for STN-DBS were voltage 1.50-2.00 V, frequency 130-145 Hz, pulse width 60-90 μs at 6 months postoperatively, and were voltage 2.00-2.50 V, frequency 130-150 Hz, pulse width 60-90 μs at one year postoperatively. The stimulus parameters for GPi- DBS were voltage 2.50-2.80 V, frequency 130-160 Hz, pulse width 60-90 μs at 6 months postoperatively, and were voltage 2.50-4.00 V, frequency 145-170 Hz, pulse width 60-90 p,s at one year postoperatively. Conclusions Both STN-DBS and GPi- DBS have good curative effect and safety in the treatment for torsion dystonia. Besides, patients should be treated with individual neuromodulation.

关 键 词：张力障碍 变形性肌 深部脑刺激法 

分 类 号：R651.1[医药卫生—外科学]