Moro E, Piboolnurak P, Arenovich T, Hung S W, Poon Y-Y, Lozano A M
Movement Disorders Center, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada.
Eur J Neurol. 2009 Apr;16(4):506-12. doi: 10.1111/j.1468-1331.2008.02520.x.
Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is successful in dystonia, but the role of each electrical parameters of stimulation is unclear. We studied the clinical effects of acute changes of different parameters of GPi-DBS in cervical dystonia (CD).
Eight CD patients with bilateral GPi-DBS at 28.6 +/- 19.2 (mean +/- SD) months after surgery were recruited. Mean improvement in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) severity score was 54.5% compared to before surgery. Ten settings, including a combination of a wide range of pulse widths (PWs), low and high frequencies and voltage, were administered in a randomized double blinded fashion. Clinical benefit was assessed by two raters using the TWSTRS and by the patients using an analogue rating scale.
The TWSTRS severity scores were reduced by 56.7% with stimulation at the best settings. Improvement was significantly associated with high frequency (> or = 60 Hz) and high voltage. Stimulation at 130 Hz showed the best clinical improvement. Increasing PWs (from 60 to 450 micros) did not result in a significant improvement.
Frequency and amplitude appear to be the most important factors in the acute anti-dystonic effects in GPi-DBS patients with CD.
内侧苍白球（GPi）的深部脑刺激（DBS）治疗肌张力障碍取得成功，但刺激的各项电参数所起的作用尚不清楚。我们研究了GPi-DBS不同参数的急性变化对颈部肌张力障碍（CD）的临床效果。
招募了8例术后28.6±19.2（平均±标准差）个月接受双侧GPi-DBS治疗的CD患者。与手术前相比，多伦多西部痉挛性斜颈评定量表（TWSTRS）严重程度评分的平均改善率为54.5%。以随机双盲方式给予10种设置，包括多种脉冲宽度（PW）、低频和高频以及电压的组合。由两名评估者使用TWSTRS进行临床获益评估，并由患者使用模拟评分量表进行评估。
在最佳设置下进行刺激时，TWSTRS严重程度评分降低了56.7%。改善与高频（≥60Hz）和高电压显著相关。130Hz的刺激显示出最佳的临床改善效果。增加PW（从60微秒至450微秒）并未带来显著改善。
频率和幅度似乎是GPi-DBS治疗CD患者急性抗肌张力障碍效应中最重要的因素。
