脑深部电刺激术治疗药物难治性原发性全身型肌张力障碍的远期疗效

摘要

Objective To evaluate the long-term efficacy of deep brain stimulation (DBS) in treatment of medically refractory primary generalized dystonia (PGD) and to compare the effect of stimulation of subthalamic nucleus (STN) with that of globus pallidus internus (GPi) in the treatment of dystonia.Methods Twenty-one cases of PGD underwent STN-DBS or GPi-DBS at Department of Neurosurgery,Tangdu Hospital,the Fourth Military Medical University from December 2004 to April 2013 and were enrolled into this study.Among them,11 patients underwent STN stimulation (STN-DBS group) and the other 10 cases received GPi stimulation (GPi-DBS group).Pre-and postoperative severity of dystonia were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS).Results The average improvement rates of BFMDRS movement subscale in the 21 cases of PGD were 63.7 ± 14.2 ％ and 66.5 ± 13.7 ％ at 1 and 3 years post operation,respectively.Meanwhile,the disability scores were reduced by 43.7 ± 13.8 ％ and 49.1 ± 12.4 ％,respectively.The movement scores in STN-DBS group were 56.9 ± 20.9 prior to surgery and 18.3 ± 6.8 at 3 years post operation,and the average improvement rate was 64.6 ± 15.2 ％.Their disability scores were 20.0(11.0) prior to surgery.and 8.0(4.0) points at 3 years post operation,and the average improvement rate was 54.5 ％ (15.0 ％).In the GPi-DBS group,the movement scores were 60.8 ± 19.3 before surgery and 18.3 ±7.9 at 3 years post surgery,and the average improvement rate was 68.6 ± 12.5 ％.Their disability scores were 17.5 ±5.4 before surgery and 8.9 ±2.5 post surgery,and the average improvement rate was 47.2 ± 12.8 ％.There was no statistically significant difference in the improvement rates of BFMDRS movement and disability scores between 2 targets at 1 year and 3 years after surgery (both P ＞ 0.05).Conclusions The effect of DBS in the treatment of medically refractory seems to be significant and sustained.Our preliminary results suggest that there is no significant difference in the long-term efficacy between stimulation of STN and stimulation of GPi for dystonia.%目的 评价脑深部电刺激术(DBS)治疗药物难治性原发性全身型肌张力障碍(PGD)的远期疗效,比较以丘脑底核(STN)为靶点的DBS(STN-DBS)和以苍白球内侧部(GPi)为靶点的DBS(GPi-DBS)治疗肌张力障碍的效果.方法 回顾性纳入2004年12月至2013年4月第四军医大学唐都医院神经外科行DBS的21例PGD患者,其中行STN-DBS治疗11例(STN-DBS组),行GPi-DBS治疗10例(GPi-DBS组).采用Burke-Fahn-Marsden肌张力障碍评定量表(BFMDRS)评估患者术前和术后肌张力障碍的严重程度.结果 与术前相比,21例PGD患者术后1、3年的BFMDRS运动评分分别下降(63.7±14.2)％和(66.5±13.7)％;残疾评分分别下降(43.7±13.8)％和(49.1±12.4)％,且与术前的差异均有统计学意义(均P ＜0.05).STN-DBS组术前和术后3年的BFMDRS运动评分分别为(56.9±20.9)分和(18.3±6.8)分,平均改善率为(64.6±15.2)％;残疾评分为20.0(11.0)分和8.0(4.0)分,平均改善率为54.5％(15.0％).GPi-DBS组术前和术后3年的BFMDRS运动评分分别为(60.8±19.3)分和(18.3±7.9)分,平均改善率为(68.6±12.5)％;残疾评分为(17.5±5.4)分和(8.9±2.5)分,平均改善率为(47.2±12.8)％.术后1、3年不同靶点刺激对BFMDRS运动评分和残疾评分改善率的差异无统计学意义(均P＞0.05).结论 DBS治疗药物难治性PGD的疗效显著且持久.STN-DBS与GPi-DBS对药物难治性PGD的远期疗效相近.