Starr Philip A, Turner Robert S, Rau Geoff, Lindsey Nadja, Heath Susan, Volz Monica, Ostrem Jill L, Marks William J
Department of Neurosurgery, University of California, San Francisco 94143, USA.
J Neurosurg. 2006 Apr;104(4):488-501. doi: 10.3171/jns.2006.104.4.488.
Deep brain stimulation (DBS) of the globus pallidus internus (GPI) is a promising new procedure for the treatment of dystonia. The authors describe their technical approach for placing electrodes into the GPI in awake patients with dystonia, including methodology for electrophysiological mapping of the GPI in the dystonic state, clinical outcomes and complications, and the location of electrodes associated with optimal benefit.
Twenty-three adult and pediatric patients with various forms of dystonia were included in this study. Baseline neurological status and DBS-related improvement in motor function were measured using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). The implantation of DBS leads was performed using magnetic resonance (MR) imaging-based stereotaxy, single-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. Electrode locations were measured on computationally reformatted postoperative MR images according to a prospective protocol.
Physiologically guided implantation of DBS electrodes in patients with dystonia was technically feasible in the awake state in most patients, and the morbidity rate was low. Spontaneous discharge rates of GPI neurons in dystonia were similar to those of globus pallidus externus neurons, such that the two nuclei must be distinguished by neuronal discharge patterns rather than rates. Active electrode locations associated with robust improvement (> 70% decrease in BFMDRS score) were located near the intercommissural plane, at a mean distance from the pallidocapsular border of 3.6 mm.
内侧苍白球（GPI）的脑深部电刺激（DBS）是一种治疗肌张力障碍很有前景的新方法。作者描述了他们在患有肌张力障碍的清醒患者中将电极植入GPI的技术方法，包括肌张力障碍状态下GPI的电生理图谱绘制方法、临床结果和并发症，以及与最佳疗效相关的电极位置。
本研究纳入了23例患有各种形式肌张力障碍的成人和儿童患者。使用伯克 - 法恩 - 马斯登肌张力障碍评定量表（BFMDRS）测量基线神经状态和DBS相关的运动功能改善情况。DBS电极的植入采用基于磁共振（MR）成像的立体定向技术、单细胞微电极记录以及术中测试刺激，以确定刺激诱发不良反应的阈值。根据前瞻性方案，在计算机重新格式化的术后MR图像上测量电极位置。
在大多数患者中，在清醒状态下对肌张力障碍患者进行生理引导下的DBS电极植入在技术上是可行的，且发病率较低。肌张力障碍中GPI神经元的自发放电率与外侧苍白球神经元相似，因此必须通过神经元放电模式而非放电率来区分这两个核。与显著改善（BFMDRS评分降低> 70%）相关的有效电极位置位于连合间平面附近，距苍白球 - 囊膜边界的平均距离为3.6 mm。
