Abstract:

Background  Deep brain stimulation (DBS) offers a very promising therapy for medically intractable dystonia. Among different dystonia subtypes, the surgical outcome of primary dystonia is most convincing, while that of post-traumatic dystonia is uncertain. This paper aims to evaluate the effect of DBS on post-traumatic dystonia. Methods  Four patients of post-traumatic dystonia treated with DBS on globus pallidus internus (GPi) or subthalamic nucleus (STN) were reviewed and their surgical effect was evaluated. Outcome assessments were based on Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) movement and disability scores preoperatively and one month, 6 months, one year and 2 years after surgery. Improvement rate was counted to evaluate the curative effect. Results BFMDRS movement scores were improved by 38.35%, 47.28%, 62.74% and 68.69% respectively, and disability scores were improved by 35.36% , 46.83% , 59.60% and 67.01% respectively. Imaging features of these patients were reviewed. Although the location and size of encephalomalacia differed among these patients, the anatomical features of basal ganglia remained intact. Conclusions  With strict selection, DBS may be a promising treatment to ameliorate the symptoms of post-traumatic dystonia. The surgical effect may be sustainable in long term. Anatomical integrity of basal ganglia may be an important factor to predict good outcome.

Key words: Dystonia, Brain injuries, Deep brain stimulation, Follow-up studies

摘要：

研究背景 脑深部电刺激术已成为外科治疗肌张力障碍的重要手段之一，原发性肌张力障碍疗效肯定，而对颅脑创伤致继发性肌张力障碍的疗效尚不确定。本文探讨脑深部电刺激术治疗颅脑创伤后肌张力障碍的疗效。方法 分别采用苍白球内侧部电刺激术和丘脑底核电刺激术治疗4 例颅脑创伤后肌张力障碍患者，分别于术前以及开启刺激器后1、6、12 和24 个月和最后一次随访时进行Burke-Fahn-Marsden 肌张力障碍量表（BFMDRS）运动障碍和功能障碍评分，计算评分改善率，评价治疗效果。结果 4 例患者开启刺激器后1、6、12 和24 个月BFMDRS 运动障碍评分平均改善率分别为38.35% 、47.28% 、62.74% 和68.69% ，功能障碍评分平均改善率分别为35.36% 、46.83% 、59.60% 和67.01%。影像学检查显示4 例患者基底节区均完好。结论 经严格选择适应证，脑深部电刺激术可有效改善颅脑创伤后肌张力障碍患者症状，且长期疗效稳定。基底节解剖结构完整可能提示预后较好。

关键词: 张力失调, 脑损伤, 深部脑刺激法, 随访研究