Department of Neurology, Surgical Movement Disorders, 1635 Divisadero Street, Fifth Floor, Suites 520-530, San Francisco, CA 94115, USA.
Neurology. 2011 Mar 8;76(10):870-8. doi: 10.1212/WNL.0b013e31820f2e4f.
The globus pallidus internus (GPi) has been the primary target for deep brain stimulation (DBS) to treat severe medication-refractory dystonia. Some patients with primary cervical or segmental dystonia develop subtle bradykinesia occurring in previously nondystonic body regions during GPi DBS. Subthalamic nucleus (STN) DBS may provide an alternative target choice for treating dystonia, but has only been described in a few short reports, without blinded rating scales, statistical analysis, or detailed neuropsychological studies.
In this prospective pilot study, we analyzed the effect of bilateral STN DBS on safety, efficacy, quality of life, and neuropsychological functioning in 9 patients with medically refractory primary cervical dystonia. Severity of dystonia was scored by a blinded rater (unaware of the patient's preoperative or postoperative status) using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) preoperatively and 3, 6, and 12 months postsurgery. Lead location, medications, and adverse events were also measured.
STN DBS was well-tolerated with no serious adverse effects. The TWSTRS total score improved (p < 0.001) from a mean (±SEM) of 53.1 (±2.57), to 19.6 (±5.48) at 12 months. Quality of life measures were also improved. STN DBS induced no consistent neuropsychological deficits. Several patients reported depression in the study and 3 had marked weight gain. No patients developed bradykinetic side effects from stimulation, but all patients developed transient dyskinetic movements during stimulation.
This prospective study showed that bilateral STN DBS resulted in improvement in dystonia and suggests that STN DBS may be an alternative to GPi DBS for treating primary cervical dystonia.
This study provides Class III evidence that bilateral subthalamic nucleus deep brain stimulation results in significant improvement in cervical dystonia without bradykinetic side effects.
苍白球内侧核（GPi）一直是深部脑刺激（DBS）治疗严重药物难治性肌张力障碍的主要靶点。一些原发性颈部或节段性肌张力障碍患者在接受 GPi-DBS 治疗时，先前无肌张力障碍的身体区域会出现轻微的运动迟缓。丘脑底核（STN）DBS 可能为肌张力障碍的治疗提供另一种选择靶点，但仅在少数短报告中有所描述，缺乏盲法评分量表、统计分析或详细的神经心理学研究。
在这项前瞻性试点研究中，我们分析了双侧 STN-DBS 对 9 例药物难治性原发性颈部肌张力障碍患者的安全性、疗效、生活质量和神经心理学功能的影响。术前和术后 3、6 和 12 个月，由盲法评分者（不了解患者术前或术后状态）使用多伦多西部痉挛性斜颈评定量表（TWSTRS）对肌张力障碍的严重程度进行评分。还测量了导联位置、药物和不良事件。
STN-DBS 耐受良好，无严重不良事件。TWSTRS 总分从术前的平均（±SEM）53.1（±2.57）改善至 12 个月时的 19.6（±5.48）（p<0.001）。生活质量测量也得到改善。STN-DBS 未引起一致的神经心理学缺陷。一些患者在研究中报告抑郁，3 人体重明显增加。没有患者因刺激而出现运动迟缓的副作用，但所有患者在刺激期间都出现短暂的运动障碍。
这项前瞻性研究表明，双侧 STN-DBS 可改善肌张力障碍，并提示 STN-DBS 可能是治疗原发性颈部肌张力障碍的 GPi-DBS 的替代方法。
这项研究提供了 III 级证据，表明双侧丘脑底核深部脑刺激可显著改善颈部肌张力障碍，且无运动迟缓副作用。
