Department of Neurology, University of California, San Francisco, Surgical Movement Disorders, 1635 Divisadero Street, 5th Floor, Suites 520-530, San Francisco, CA 94115, USA; Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (p-127), San Francisco, CA 94121, USA.
Department of Neurology, University of California, San Francisco, Surgical Movement Disorders, 1635 Divisadero Street, 5th Floor, Suites 520-530, San Francisco, CA 94115, USA; Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (p-127), San Francisco, CA 94121, USA.
Parkinsonism Relat Disord. 2014 Apr;20(4):432-8. doi: 10.1016/j.parkreldis.2013.12.012. Epub 2014 Jan 5.
Subthalamic nucleus deep brain stimulation (DBS) is an alternative target choice for treating primary dystonia, but little is known about the most effective programming parameters.
Here we prospectively evaluate the effect of low versus high frequency subthalamic nucleus DBS in patients with predominantly cervical or upper extremity primary dystonia.
Seven patients were stimulated at low frequency stimulation (60 Hz) for the first three months and then switched to high frequency stimulation (130 Hz) until month six. Severity of dystonia was determined by a blinded rater (unaware of the patient's pre or post-operative status) who scored the Burke Fahn Marsden dystonia rating scale movement score (BFMDRS-M) and the Toronto Western Spasmodic Torticollis Rating Scale severity score (TWSTRS-S) preoperatively, three, six, and twelve months post-surgery.
Patients had a lower mean improvement of 16.6% in BFMDRS-M and 9.5% in TWSTRS-S at three months using low frequency stimulation compared to a 52.3% (p = 0.018) and 45.2% (p = 0.028), respectively, noted at six months using high frequency stimulation. At 12 months (using 130 Hz), the BFMDRS-M and TWSTRS-S improved by 51.8% (p = 0.022) and 56% (p = 0.034). Patients developed transient dyskinesia (during low and high frequency stimulation) which improved with programming adjustments.
This study offers further support of the effectiveness of subthalamic nucleus DBS in the treatment of primary dystonia and finds that high frequency stimulation was more effective than low frequency stimulation.
丘脑底核深部脑刺激(DBS)是治疗原发性肌张力障碍的另一种靶目标选择,但对于最有效的程控参数知之甚少。
本研究前瞻性评估低频率与高频率丘脑底核 DBS 对以颈部或上肢为主的原发性肌张力障碍患者的影响。
7 名患者在前 3 个月接受低频刺激(60 Hz),然后切换至高频率刺激(130 Hz)至 6 个月。由一名盲法评定者(不了解患者的术前或术后状态)根据 Burke-Fahn-Marsden 肌张力障碍评定量表运动评分(BFMDRS-M)和多伦多西部痉挛性斜颈评定量表严重程度评分(TWSTRS-S)评定术前、术后 3、6 和 12 个月的肌张力障碍严重程度。
与 6 个月时使用高频率刺激时的 52.3%(p = 0.018)和 45.2%(p = 0.028)相比,低频刺激时患者 BFMDRS-M 和 TWSTRS-S 的平均改善分别为 16.6%和 9.5%,而在 6 个月时使用高频率刺激时分别为 52.3%(p = 0.018)和 45.2%(p = 0.028)。在 12 个月(使用 130 Hz)时,BFMDRS-M 和 TWSTRS-S 分别改善了 51.8%(p = 0.022)和 56%(p = 0.034)。患者出现短暂性运动障碍(在低频和高频刺激期间),通过程控调整得到改善。
本研究进一步支持丘脑底核 DBS 治疗原发性肌张力障碍的有效性,并发现高频刺激比低频刺激更有效。