Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France.
Division of Neurology, A.O.U.C., University of Florence, Florence, Italy.
J Neurol Neurosurg Psychiatry. 2017 Nov;88(11):960-967. doi: 10.1136/jnnp-2016-315504. Epub 2017 Sep 28.
Pallidal deep brain stimulation (globus pallidus internus (GPi) DBS) is the best therapeutic option for disabling isolated idiopathic (IID) and inherited (INH) dystonia. Acquired dystonia (AD) may also benefit from GPi DBS. Efficacy and safety in the long-term remained to be established.
To retrospectively assess long-term clinical outcomes and safety in dystonic patients who underwent GPi DBS.
Patients were videotaped and assessed preoperatively and postoperatively (1-year and at last available follow-up) using the Burke-Fahn-Marsden Dystonia Rating Scale (motor score (BFMDRS-M); disability score (BFMDRS-D)).
Sixty-one patients were included (follow-up 7.9±5.9 years; range 1-20.7). In IID and INH (n=37), the BFMDRS-M improved at first (20.4±24.5; p<0.00001) and last (22.2±18.2; p<0.001) follow-ups compared with preoperatively (50.5±28.0). In AD (n=19), the BFMDRS-M ameliorated at 1-year (40.8±26.5; p<0.02) and late follow-ups (44.3±24.3; p<0.04) compared with preoperatively (52.8±24.2). In INH dystonia with other neurological features (n=4) there was no motor benefit. In IID and INH, the BFMDRS-D improved at 1-year (9.5±7.5; p<0.0002) and late follow-ups (10.4±7.8; p<0.016) compared with preoperatively (13.3±6.9). In AD, the BFMDRS-D reduced at 1-year (12.0±8.1; p<0.01) and late follow-ups (12.7 ±6.1; p=0.2) compared with preoperatively (14.35±5.7). Most adverse events were hardware related.
GPi DBS is an effective and safe treatment in most patients with dystonia.
苍白球深部脑刺激（苍白球 internus (GPi) DBS）是治疗失能性特发性（IID）和遗传性（INH）肌张力障碍的最佳治疗选择。获得性肌张力障碍（AD）也可能受益于 GPi DBS。其长期疗效和安全性仍有待确定。
回顾性评估接受 GPi DBS 的肌张力障碍患者的长期临床疗效和安全性。
患者术前和术后（1 年和最后一次随访）进行录像并使用 Burke-Fahn-Marsden 肌张力障碍评定量表（运动评分（BFMDRS-M）；残疾评分（BFMDRS-D））进行评估。
共纳入 61 例患者（随访时间 7.9±5.9 年；范围 1-20.7 年）。在 IID 和 INH（n=37）中，BFMDRS-M 在首次（20.4±24.5；p<0.00001）和末次（22.2±18.2；p<0.001）随访时均较术前（50.5±28.0）改善。在 AD（n=19）中，BFMDRS-M 在 1 年（40.8±26.5；p<0.02）和晚期随访（44.3±24.3；p<0.04）时均较术前（52.8±24.2）改善。在 INH 伴有其他神经功能障碍的肌张力障碍（n=4）中，运动功能无改善。在 IID 和 INH 中，BFMDRS-D 在 1 年（9.5±7.5；p<0.0002）和晚期随访（10.4±7.8；p<0.016）时均较术前（13.3±6.9）改善。在 AD 中，BFMDRS-D 在 1 年（12.0±8.1；p<0.01）和晚期随访（12.7 ±6.1；p=0.2）时均较术前（14.35±5.7）降低。大多数不良事件与硬件有关。
GPi DBS 是大多数肌张力障碍患者有效且安全的治疗方法。
