摘要
目的探讨国产脑深部电刺激（DBS）系统治疗全身型肌张力障碍的效果。方法回顾性纳入2013年7月至2016年9月中国医学科学院，北京协和医学院，北京协和医院神经外科应用国产DBS系统治疗的20例全身型肌张力障碍患者，其中原发性13例，继发性7例。其中10例以苍白球内侧部（GPi）为DBS靶点（GPi—DBS组），另10例以丘脑底核（STN）为DBS靶点（STN—DBS组）。分别于术前，术后3、6、12个月采用Burke—Fahn—Marsden肌张力障碍运动评分量表（BFMDRS—M）和功能障碍评分量表（BFMDRS—D）评估患者的运动和功能障碍情况，计算术后12个月的评分改善率，评价国产DBS系统治疗全身型肌张力障碍的有效性。比较GPi．DBS组和STN—DBS组的评分改善情况及其刺激参数。结果原发性和继发性全身型肌张力障碍患者术后12个月的BFMDRS—M评分改善率（中位数）分别为86．1％和43．9％，BFMDRS—D评分改善率（中位数）分别为66．7％和44．4％，差异均有统计学意义（均P〈0．001）。GPi—DBS和STN—DBS治疗全身型肌张力障碍有效性的差异无统计学意义（P〉0．05）。GPi—DBS组的刺激电压、频率、波幅均显著高于STN—DBS组（均尸〈0．05）。随访时间为12-48个月。20例患者中，仅2例在程控中出现异动，无一例发生严重并发症。结论国产DBS系统能明显改善全身型肌张力障碍患者的症状，其治疗安全、有效。
Objective To evaluate the efficacy of deep brain stimulation in treatment of generalized dystonia. Methods A retrospective analysis was conducted on 20 patients who were implanted with a PINS device at Department of Neurosurgery, Peking Union Medical College Hospital from July 2013 to September 2016. Among them, 13 cases were primary generalized dystonia and 7 cases had secondary generalized dystonia. The scores of Burke-Fabn-Marsden dystonia movement/disability were documented at baseline and at 3, 6, 12 months of follow-up. The rate of improvement was assessed at 12 months postoperatively to evaluate the effectiveness of the PINS DBS system. C-mparison was conducted regarding the improvement of scores between groups with different targets and parameters of stimulation. Results Compared with preoperative state, the improvement rates of median BFMDRS-M （Burke-Fahn-Marsden Dystonia Rating Scale-Movement） scores were 86. 1% and 43.9% in patients with primary and secondary systemic dystonia at 12 months post surgery, respectively. The improvement rates of median BFMDRS-D （Bttrke-Fahn-Marsden Dystonia Rating Scale-Disability） scores were 66.7% and 44.4%, respectively, and there was significant difference between pre- and post-operative states （both P 〈0.001）. There was no significant difference between the efficacy of GPi-DBS and that of STN-DBS in the treatment of systemic dystonia （P 〉 0. 05）. However, the stimulation parameters of STN-DBS group were significantly lower than those of GPi-DBS group （all P 〈 0. 05） in terms of voltage, frequency and amplitude. The follow-up lasted 12-48 months. Only 2 cases developed dyskinesia as the adverse event which resolved or obtained improvement by the end of the study. No adverse effects were classified as severe. Conclusions The deep brain stimulation system domestically manufactured could significantly improve the symptoms of generalized dystonia and demonstrates safety and effectiveness.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第11期1128-1132,共5页
Chinese Journal of Neurosurgery
基金
国家重点研发计划（2016YFC0105900）
