Kupsch Andreas, Kuehn Andrea, Klaffke Stefanie, Meissner Wassilios, Harnack Daniel, Winter Christine, Haelbig Thomas D, Kivi Anatol, Arnold Guy, Einhäupl Karl-Max, Schneider Gerd-Helge, Trottenberg Thomas
Dept. of Neurology and Neurosurgery, Augustenburger Platz 1, 13353 Berlin, Germany.
J Neurol. 2003 Feb;250 Suppl 1:I47-52. doi: 10.1007/s00415-003-1110-2.
Renewed interest in stereotaxy for dystonia followed the introduction of deep brain stimulation (DBS) in Parkinson's disease and essential tremor in the 1990s. DBS evolved from ablative surgery, which was applied with varying results in the 1950s in patients with movement disorders such as Parkinson's disease, essential tremor and dystonia. The present review summarizes the current knowledge on clinical aspects of DBS in dystonia (Dec. 2002). Excellent results have been achieved in dystonic patients carrying a mutation in the DYT1 gene with improvements up to 90 %. Similar results may also be obtained in patients with idiopathic generalized dystonia, myoclonus-dystonia syndrome, and tardive dystonia. Substantial improvement has been observed in patients with focal dystonia (for instance cervical dystonia). Patients with secondary dystonia often display a lesser and more variable degree of improvement. Long-term studies are warranted to assess both motor and neuropsychological sequelae of DBS in dystonia. Furthermore, the optimal target for different dystonic disorders remains to be determined, although the globus pallidus internus has currently emerged as the most promising target for dystonia.
20世纪90年代，随着帕金森病和特发性震颤的深部脑刺激（DBS）技术的引入，人们对肌张力障碍的立体定向技术重新产生了兴趣。DBS起源于毁损性手术，20世纪50年代，该手术应用于帕金森病、特发性震颤和肌张力障碍等运动障碍患者，疗效各异。本综述总结了目前关于DBS治疗肌张力障碍临床方面的知识（2002年12月）。携带DYT1基因突变的肌张力障碍患者取得了优异的治疗效果，改善率高达90%。特发性全身性肌张力障碍、肌阵挛性肌张力障碍综合征和迟发性肌张力障碍患者也可能获得类似的结果。局灶性肌张力障碍（如颈部肌张力障碍）患者有显著改善。继发性肌张力障碍患者的改善程度通常较小且变化较大。有必要进行长期研究，以评估DBS治疗肌张力障碍的运动和神经心理后遗症。此外，尽管目前内侧苍白球已成为治疗肌张力障碍最有前景的靶点，但不同肌张力障碍疾病的最佳靶点仍有待确定。
