Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH 44195, USA.
Cleve Clin J Med. 2012 Jul;79 Suppl 2:S40-3. doi: 10.3949/ccjm.79.s2a.08.
Deep brain stimulation (DBS) is among the most effective approaches for the treatment of patients with advanced movement disorders. In patients with essential tremor, stimulation typically targets the ventral intermediate nucleus of the thalamus. Results of several studies have shown that over a follow-up period of 1 to 5 years, the severity of tremor decreases by an average of approximately 50% from baseline. Ongoing research continues to define the optimal stimulation parameters for patients with tremor, including frequency, voltage, and pulse width. In patients with dystonia, DBS typically targets the globus pallidus internus or the subthalamic nucleus. Long-term prospective clinical trials demonstrated reductions in motor severity rating scale scores of approximately 50% to 80% over follow-up periods of 2 to 3 years. Serious adverse events were uncommon, and included lead failures and infections. Appropriate candidates for DBS treatment of dystonia include patients with an unequivocal diagnosis of dystonia and significant disability. Several issues in the use of DBS for movement disorders remain unresolved, including the intensity of appropriate medical management before undergoing DBS, the importance of intraoperative mapping, optimal stimulator programming, and the time course of the beneficial effects of treatment.
脑深部刺激（DBS）是治疗晚期运动障碍患者的最有效方法之一。对于特发性震颤患者，刺激通常针对丘脑腹中间核。几项研究的结果表明，在 1 至 5 年的随访期间，震颤的严重程度平均从基线下降约 50%。正在进行的研究继续为震颤患者定义最佳的刺激参数，包括频率、电压和脉冲宽度。对于肌张力障碍患者，DBS 通常针对苍白球内侧部或丘脑底核。长期前瞻性临床试验表明，在 2 至 3 年的随访期间，运动严重程度评分平均降低 50%至 80%。严重不良事件并不常见，包括导线故障和感染。适合 DBS 治疗肌张力障碍的患者包括明确诊断为肌张力障碍且存在显著残疾的患者。在运动障碍的 DBS 应用中仍存在一些未解决的问题，包括在进行 DBS 之前进行适当的药物治疗的强度、术中映射的重要性、最佳刺激器编程以及治疗的有益效果的时间过程。
