双侧丘脑底核电刺激治疗原发性肌张力障碍

目的 研究双侧丘脑底核（STN）脑深部电刺激术（DBS）治疗原发性肌张力障碍的长期疗效：方法 比较15例行舣侧STN—DBS治疗的原发性肌张力障碍患者，手术前后的Burke—Fahn—Marsden肌张力障碍评分改善程度及长期改善效果。结果 15例原发性肌张力障碍患者中12例在开启刺激器后症状即刻得到部分缓解，以不自主运动、异常姿势及躯体的扭转改善为主，其中9例在刺激1—3d后、3例刺激1，周后改善75％以上，6个月后平均改善92％；1例在2个月后开始改善，6个月后改善90％以上；2例在1个月开始出现轻微改善，6个月后改善了76％：15例患者的长期随访结果显示其疗效稳定，经过1—3次程控后不需经常调整刺激参数：所有患者未出现手术相关并发症及永久性副作用。结论 双侧丘脑底核脑深部电刺激术对原发性肌张力障碍有显著的治疗效果，且疗效持久、稳定，无并发症及永久性副作用。比较GPi—DBS而言，STN—DBS起效快、最件刺激化点及参数易于确定、刺激参数水平低、长期疗效稳定，可能是原发性肌张力障碍DBS治疗的理想靶点。

Subthalamic nucleus stimulation for idiopathic generalized dystonia

Objectives To evaluate long-term therapeutic effects of bilateral STN-DBS on idiopathic dystonia.Methods Compared 15 idiopathic dystonia patients who underwent STN-DBS therapy,based on of pre-and post-operative Burke-Fahn-Marsden Dystonia Scale.Results Among the15 idiopathic dystonia patients,12 had significant and immediate improvements after stimulation on.9 of them improved by 75% after 1 to 3 days of stimuli,and 3 of them after 1 week of stimuli.After 3 months of stimuli,they had an average improvement of 92%.One case began having progress after 2 months of stimulus,and had a 90%- improvement after 6 months.Two cases slightly improved after 1 month,and bad a 76%-improvement after 6 months.All patients received long-term follow-up study (8-54 months,mean 37.5 months),and it was found that the therapeutic effects were stable after one to three times of programming.Conclusions Bila teral STN-DBS have significant,long,and stable therapeutic effects on idiopathic dystonia without complications and permanent side-effects.When compared with GPi-DBS,STN-DBS stimulus has a more immediate effect,the programming is easier to determine,the stimulus is lower and effects are stable.As a result,it may be a better DBS target over GPi for idiopathic dystonia.