运动皮层刺激并不能改善由局灶性基底节病变引起的肌张力障碍。

Motor cortex stimulation does not improve dystonia secondary to a focal basal ganglia lesion.

机构信息

From the CHU Clermont-Ferrand, Neurology Department (I.R., P.D., F.D.), and Neurosurgery Department (J.J.L.), Clermont-Ferrand; Clermont Université (I.R., P.D., F.D.), Université d'Auvergne, Clermont-Ferrand; Movement Disorder Unit (M.A.K., P.P.), Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University and INSERM, Grenoble Institut des Neurosciences, Grenoble; Hospices Civils de Lyon, Hopital Neurologique Pierre Wertheimer, Neurologie C (S.T., J.X., E.B.), and Neurochirurgie A (P.M.); Université de Lyon (S.T., E.B., P.M.), Faculte de Médecine Lyon Sud Charles Mérieux, Lyon; CHU Clermont-Ferrand (B.P.), Biostatistics Unit, DRCI, Clermont-Ferrand; Department of Neurology (M.V.), CRICM UPMC/INSERM UMR_S975 CNRS UMR7225, Brain and Spine Institute, ICM, Pierre Marie Curie Paris-6 University, Salpêtrière Hospital, Paris; Univ Bordeaux (P.B.), Institut des Maladies Neurodégénératives, UMR 5293 and Service d'Explorations Fonctionnelles du Système Nerveux, Centre Hospitalier Universitaire, Bordeaux; Université Paris Est Créteil (J.P.L.), EA 4391 and AP-HP, Hôpital Henri Mondor, Service de Physiologie, Explorations Fonctionnelles, Créteil; and CHU Grenoble (S.C.), Neurosurgery Department, Grenoble, France.

出版信息

Neurology. 2014 Jan 14;82(2):156-62. doi: 10.1212/WNL.0000000000000012. Epub 2013 Dec 6.

DOI:10.1212/WNL.0000000000000012

PMID:24319038

Abstract

OBJECTIVE

To assess the efficacy of epidural motor cortex stimulation (MCS) on dystonia, spasticity, pain, and quality of life in patients with dystonia secondary to a focal basal ganglia (BG) lesion.

METHODS

In this double-blind, crossover, multicenter study, 5 patients with dystonia secondary to a focal BG lesion were included. Two quadripolar leads were implanted epidurally over the primary motor (M1) and premotor cortices, contralateral to the most dystonic side. The leads were placed parallel to the central sulcus. Only the posterior lead over M1 was activated in this study. The most lateral or medial contact of the lead (depending on whether the dystonia predominated in the upper or lower limb) was selected as the anode, and the other 3 as cathodes. One month postoperatively, patients were randomly assigned to on- or off-stimulation for 3 months each, with a 1-month washout between the 2 conditions. Voltage, frequency, and pulse width were fixed at 3.8 V, 40 Hz, and 60 μs, respectively. Evaluations of dystonia (Burke-Fahn-Marsden Scale), spasticity (Ashworth score), pain intensity (visual analog scale), and quality of life (36-Item Short Form Health Survey) were performed before surgery and after each period of stimulation.

RESULTS

Burke-Fahn-Marsden Scale, Ashworth score, pain intensity, and quality of life were not statistically significantly modified by MCS.

CONCLUSIONS

Bipolar epidural MCS failed to improve any clinical feature in dystonia secondary to a focal BG lesion.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that bipolar epidural MCS with the anode placed over the motor representation of the most affected limb failed to improve any clinical feature in dystonia secondary to a focal BG lesion.

摘要

目的

评估硬膜外运动皮层刺激（MCS）对因基底神经节（BG）局灶性病变继发的肌张力障碍、痉挛、疼痛和生活质量的疗效。

方法

在这项双盲、交叉、多中心研究中，纳入了 5 名因 BG 局灶性病变继发的肌张力障碍患者。将两个四极导联植入硬膜外，位于对侧最痉挛侧的初级运动（M1）和运动前皮质。导联与中央沟平行放置。在这项研究中仅激活 M1 上的后导联。根据上肢或下肢痉挛的优势，选择导联的最外侧或最内侧触点（取决于上肢或下肢痉挛的优势）作为阳极，其他 3 个触点作为阴极。术后 1 个月，患者被随机分配至刺激开启或关闭 3 个月，2 种状态之间有 1 个月洗脱期。电压、频率和脉冲宽度分别固定在 3.8 V、40 Hz 和 60 μs。在手术前和每个刺激期后，对肌张力障碍（Burke-Fahn-Marsden 量表）、痉挛（Ashworth 评分）、疼痛强度（视觉模拟评分）和生活质量（36 项简短健康调查问卷）进行评估。