Krauss Joachim K, Yianni John, Loher Thomas J, Aziz Tipu Z
Department of Neurosurgery, University Hospital, Klinikum Mannheim, Mannheim, Germany.
J Clin Neurophysiol. 2004 Jan-Feb;21(1):18-30. doi: 10.1097/00004691-200401000-00004.
Within the past few years, there has been a renaissance of functional neurosurgery for the treatment of dystonic movement disorders. In particular, deep brain stimulation (DBS) has widened the spectrum of therapeutical options for patients with otherwise intractable dystonia. It has been introduced only with a delay after DBS became an accepted treatment for advanced Parkinson' disease (PD). In this overview, the authors summarize the current status of its clinical application in dystonia. Deep brain stimulation for dystonia has been developed from radiofrequency lesioning, but it has replaced the latter largely in most centers. The main target used for primary dystonia is the posteroventral globus pallidus internus (GPi), and its efficacy has been shown in generalized dystonia, segmental dystonia, and complex cervical dystonia. The optimal target for secondary dystonias is still unclear, but some patients appear to benefit more from thalamic stimulation. The improvement of dystonia with chronic DBS frequently is delayed, in particular concerning tonic dystonic postures. Because more energy is needed for stimulation than in other movement disorders such as PD, more frequent battery replacements are necessary, which results in relatively higher costs for chronic DBS. The study of intraoperative microelectrode recordings and of local field potentials by the implanted DBS electrodes has yielded new insights in the pathophysiology of dystonia. Larger studies are underway presently to validate the observations being made.
在过去几年中，用于治疗肌张力障碍性运动障碍的功能性神经外科手术迎来了复兴。特别是，深部脑刺激（DBS）拓宽了原本难以治疗的肌张力障碍患者的治疗选择范围。在DBS成为晚期帕金森病（PD）的公认治疗方法之后，它才被引入。在本综述中，作者总结了其在肌张力障碍临床应用的现状。用于肌张力障碍的深部脑刺激是从射频毁损发展而来的，但在大多数中心它已在很大程度上取代了后者。用于原发性肌张力障碍的主要靶点是苍白球内侧部腹后部（GPi），其疗效已在全身性肌张力障碍、节段性肌张力障碍和复杂性颈部肌张力障碍中得到证实。继发性肌张力障碍的最佳靶点仍不清楚，但一些患者似乎从丘脑刺激中获益更多。慢性DBS对肌张力障碍的改善通常会延迟，尤其是在强直性肌张力障碍姿势方面。由于与帕金森病等其他运动障碍相比，刺激需要更多能量，因此需要更频繁地更换电池，这导致慢性DBS的成本相对较高。对术中微电极记录以及植入的DBS电极的局部场电位的研究，为肌张力障碍的病理生理学带来了新的见解。目前正在进行更大规模的研究以验证所做的观察结果。
