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 ~ 3 d、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 ~ 2.00 V，频率130 ~ 145 Hz，脉宽60 ~ 90 μs；1 年时刺激参数为电压2.00 ~ 2.50 V，频率130 ~ 150 Hz，脉宽60 ~ 90 μs。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 ~ 2.80 V，频率130 ~ 160 Hz，脉宽60 ~ 90 μs；1 年时刺激参数为电压2.50 ~ 4.00 V，频率145 ~ 170 Hz，脉宽60 ~ 90 μs。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。

关键词: 张力障碍, 变形性肌, 深部脑刺激法

Abstract:

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 μs 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.

Key words: Dystonia musculorum deformans, Deep brain stimulation