Shaikh Aasef G, Mewes Klaus, DeLong Mahlon R, Gross Robert E, Triche Shirley D, Jinnah H A, Boulis Nicholas, Willie Jon T, Freeman Alan, Alexander Garrett E, Aia Pratibha, Butefisch Cathrine M, Esper Christine D, Factor Stewart A
Department of Neurology, Emory University, Atlanta, GA, USA.
Department of Neurology, Emory University, Atlanta, GA, USA.
Parkinsonism Relat Disord. 2015 Feb;21(2):116-9. doi: 10.1016/j.parkreldis.2014.11.013. Epub 2014 Nov 20.
Several case reports and small series have indicated that tardive dystonia is responsive to globus pallidus deep brain stimulation. Whether different subtypes or distributions of tardive dystonia are associated with different outcomes remains unknown.
We assessed the outcomes and temporal profile of improvement of eight tardive dystonia patients who underwent globus pallidus deep brain stimulation over the past six years through record review. Due to the retrospective nature of this study, it was not blinded or placebo controlled.
Consistent with previous studies, deep brain stimulation improved the overall the Burke-Fahn-Marsden motor scores by 85.1 ± 13.5%. The distributions with best responses in descending order were upper face, lower face, larynx/pharynx, limbs, trunk, and neck. Patients with prominent cervical dystonia demonstrated improvement in the Toronto Western Spasmodic Torticollis Rating Scale but improvements took several months. In four patients the effects of deep brain stimulation on improvement in Burke Fahn Marsden score was rapid, while in four cases there was partial rapid response of neck and trunk dystonia followed by was gradual resolution of residual symptoms over 48 months.
Our retrospective analysis shows excellent resolution of tardive dystonia after globus pallidus deep brain stimulation. We found instantaneous response, except with neck and trunk dystonia where partial recovery was followed by further resolution at slower rate. Such outcome is encouraging for using deep brain stimulation in treatment of tardive dystonia.
多项病例报告和小型系列研究表明，迟发性肌张力障碍对苍白球深部脑刺激有反应。迟发性肌张力障碍的不同亚型或分布是否与不同结果相关仍不清楚。
我们通过记录回顾评估了过去六年中接受苍白球深部脑刺激的8例迟发性肌张力障碍患者的治疗结果及改善的时间过程。由于本研究的回顾性性质，未设盲或采用安慰剂对照。
与先前研究一致，深部脑刺激使伯克-法恩-马斯登运动评分总体提高了85.1±13.5%。最佳反应分布从高到低依次为上面部、下面部、喉/咽、肢体、躯干和颈部。伴有明显颈部肌张力障碍的患者在多伦多西部痉挛性斜颈评定量表上有改善，但改善需要数月时间。4例患者深部脑刺激对伯克-法恩-马斯登评分的改善迅速，而在4例患者中，颈部和躯干肌张力障碍有部分快速反应，随后在48个月内残余症状逐渐缓解。
我们的回顾性分析显示，苍白球深部脑刺激后迟发性肌张力障碍得到了很好的缓解。我们发现除颈部和躯干肌张力障碍外均有即时反应，颈部和躯干肌张力障碍部分恢复后以较慢速度进一步缓解。这样的结果对于使用深部脑刺激治疗迟发性肌张力障碍是令人鼓舞的。
