Meige综合征丘脑底核脑深部电刺激术后平衡和步态障碍分析

doi:10.3969/j.issn.1672-6731.2020.12.007

摘要/Abstract

摘要：

目的总结分析Meige综合征患者丘脑底核脑深部电刺激术（STN-DBS）后平衡和步态障碍原因。方法 2015年7月至2019年9月共14例患者于双侧STN-DBS术后出现平衡和步态障碍，通过Burke-Fahn-Marsden肌张力障碍量表（BFMDRS）、Tinetti平衡和步态量表（TBGA）对其术前和末次随访时肌张力障碍程度、平衡和步态障碍程度进行评价，并分析原因。结果 14例患者STN-DBS刺激方式均为单极刺激，平均随访（28.36±9.52）个月。至末次随访时，BFMDRS总评分改善率（79.57±22.21）%，其中运动评分改善率（78.68±19.91）%、功能障碍评分（72.99±46.54）%，至末次随访时BFMDRS总评分（Z=-4.055，P=0.000）和运动评分（Z=-3.919，P=0.000）均低于术前；TBGA总评分恶化率为（28.61±9.66）%，其中平衡评分恶化率（22.05±10.32）%、步态评分（37.39±9.79）%，末次随访时TBGA总评分（Z=-4.658，P=0.000）、平衡评分（Z=-3.325，P=0.001）和步态评分（Z=-3.324，P=0.001）均低于术前。随访期间通过调整程控参数或更换刺激触点，6例平衡和步态障碍明显改善、8例改善不明显。结论 Meige综合征患者行STN-DBS后可出现一定比例的平衡和步态障碍，调整刺激触点和程控参数仅对部分病例有效，更换其他刺激模式（双极刺激、变频刺激、循环刺激等）是否有效，尚待进一步观察。

关键词: Meige综合征, 丘脑底核, 深部脑刺激法, 姿势平衡, 步态障碍, 神经性

Abstract:

Objective To summarize and analyze the data of postural balance and gait disorders in patients with Meige's syndrome (MS) who underwent subthalamic nucleus deep brain stimulation (STN-DBS). Methods The study included 14 patients with MS who underwent bilateral STN-DBS surgery from July 2015 to September 2019 and developed postural balance and gait disorders. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Tinetti Balance and Gait Analysis (TBGA) were used to assess the degrees of dystonia and balance, and gait disorders at the time of preoperative and final follow-up, respectively. Results The STN-DBS stimulation mode was unipolar in all 14 patients, and all showed some degrees of postural balance and gait disorders. The mean follow-up time was (28.36±9.52) months. At the last follow-up, the overall improvement in BFMDRS score was (79.57±22.21)%, among which the improvement rate of the motor score was (78.68±19.91)% and the dysfunction score was (72.99±46.54)%. The total score of BFMDRS (Z=-4.055, P=0.000) and the motor score (Z=-3.919, P=0.000) were lower than those before operation. The deterioration rate of TBGA was (28.61±9.66)%, including of balance score (22.05±10.32)% and gait score (37.39±9.79)%. Total TBGA score (Z=-4.658, P=0.000), balance score (Z=-3.325, P=0.001) and gait score (Z=-3.324, P=0.001) were all lower than those before operation. By adjusting program-controlled parameters or changing stimulation contacts during the follow-up period, balance and gait disorder were improved obviously in 6 patients, however, 8 patients' symptoms were not improved well. Conclusions Patients with MS may experience a certain percentage of balance and gait disorders after treatment with STN-DBS. By adjusting the stimulation contact and changing the program-controlled parameters, it is only effective for some patients. Whether the other stimulation modes (bipolar stimulation, frequency conversion stimulation, cyclic stimulation, etc.) are effective or not remains to be studied.

Key words: Meige syndrome, Subthalamic nucleus, Deep brain stimulation, Postural balance, Gait disorders, neurologic

王宁, 王晓松, 郭宇鹏, 付宗荟, 陈国强, 王林. Meige综合征丘脑底核脑深部电刺激术后平衡和步态障碍分析[J]. 中国现代神经疾病杂志, 2020, 20(12): 1066-1071.

WANG Ning, WANG Xiao-song, GUO Yu-peng, FU Zong-hui, CHEN Guo-qiang, WANG Lin. Clinical analysis of balance and gait disorders after subthalamic nucleus deep brain stimulation in patients with Meige's syndrome[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(12): 1066-1071.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I12/1066

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Clinical analysis of balance and gait disorders after subthalamic nucleus deep brain stimulation in patients with Meige's syndrome

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2 Meige综合征丘脑底核脑深部电刺激术后平衡和步态障碍分析

Clinical analysis of balance and gait disorders after subthalamic nucleus deep brain stimulation in patients with Meige's syndrome

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