Sun B, Chen S, Zhan S, Le W, Krahl S E
Center for Functional Neurosurgery, Shanghai Jiao Ton University Ruijin Hospital, Shanghai, PR China.
Acta Neurochir Suppl. 2007;97(Pt 2):207-14. doi: 10.1007/978-3-211-33081-4_23.
With the renaissance of stereotactic pallidotomy for Parkinson's disease in 1990s, pallidotomy has become increasingly used as an effective treatment for various manifestations of medically refractory dystonia. More recently, deep brain stimulation of globus pallidus internus (GPi) has been replacing pallidotomy. Although GPi DBS has great promise for treating dystonia, there are some disadvantages. We introduce our experiences in subthalamic nucleus (STN) DBS for primary dystonia and tardive dystonia in this chapter. We propose that STN DBS has the following advantages over GPi DBS: (1) symptomatic improvement is seen immediately after stimulation, allowing us to quickly select the most suitable stimulation parameters; (2) the stimulation parameters for the STN are lower than those used for the GPi, resulting in longer battery life; and (3) STN DBS results in better symptomatic control than GPi DBS in dystonia patients when our STN data is compared to that obtained by others with using the GPi as the target. We suggest that STN DBS may be the most appropriate surgical technique for dystonia.
随着20世纪90年代帕金森病立体定向苍白球毁损术的复兴，苍白球毁损术越来越多地被用作治疗各种药物难治性肌张力障碍表现的有效方法。最近，内侧苍白球（GPi）的脑深部电刺激（DBS）已逐渐取代苍白球毁损术。尽管GPi DBS在治疗肌张力障碍方面前景广阔，但也存在一些缺点。在本章中，我们介绍了我们在丘脑底核（STN）DBS治疗原发性肌张力障碍和迟发性肌张力障碍方面的经验。我们提出，与GPi DBS相比，STN DBS具有以下优势：（1）刺激后症状立即改善，使我们能够快速选择最合适的刺激参数；（2）STN的刺激参数低于GPi，从而延长电池寿命；（3）当将我们的STN数据与其他以GPi为靶点获得的数据进行比较时，STN DBS在肌张力障碍患者中比GPi DBS能更好地控制症状。我们认为，STN DBS可能是治疗肌张力障碍最合适的手术技术。
