Kim Ji Hee, Jung Na Young, Chang Won Seok, Jung Hyun Ho, Cho Sung-Rae, Chang Jin Woo
Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea.
Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Severance Intrathecal Pump Clinic, Yonsei University College of Medicine, Seoul, Korea.
World Neurosurg. 2019 Jun;126:e550-e556. doi: 10.1016/j.wneu.2019.02.092. Epub 2019 Mar 1.
There is no consensus on a standardized approach to spasticity or dystonia management of cerebral palsy (CP). This study aimed to investigate clinical outcomes and compare therapeutic responses for pallidal stimulation versus intrathecal baclofen (ITB) therapy in adult patients with severe CP.
We retrospectively reviewed patients with CP treated with deep brain stimulation (DBS) of the globus pallidus internus (GPi) or implantation of ITB pump between June 2003 and April 2017. Patients were included if they were clinically diagnosed with medically intractable CP and had >12 months of postprocedural follow-up data. Patients were assessed before and 12 months post-treatment using the visual analogue scale, Burke-Fahn-Marsden Dystonia Rating Scale, self-rating improvement scale, and 36-Item Short-Form General Health Survey Questionnaire.
Patients (n = 22) were divided into GPi DBS (n = 12) and ITB therapy (n = 10) groups. For the Burke-Fahn-Marsden Dystonia Rating Scale, DBS group movement scores and ITB group disability scores were significantly improved post-treatment. Although visual analogue scales did not differ between groups, self-rating improvement scores differed significantly between groups. For quality of life, physical functioning, body pain, vitality, social functioning, and mental health significantly improved in ITB group 12 months post-treatment compared with those of preoperative period. Only mental health differed significantly between groups.
Despite retrospective design and relatively low number of cases, this study indicated that ITB therapy was less invasive and more effective in improving the quality of life compared with GPi DBS. ITB therapy should be considered an alternative treatment for patients with severe CP.
对于脑瘫（CP）痉挛或肌张力障碍的标准化管理方法尚无共识。本研究旨在调查成年重度CP患者苍白球刺激与鞘内注射巴氯芬（ITB）治疗的临床结果并比较治疗反应。
我们回顾性分析了2003年6月至2017年4月间接受内侧苍白球（GPi）深部脑刺激（DBS）或ITB泵植入治疗的CP患者。如果患者临床诊断为药物难治性CP且有>12个月的术后随访数据，则纳入研究。在治疗前和治疗后12个月使用视觉模拟量表、伯克-法恩-马斯登肌张力障碍评定量表、自评改善量表和36项简短形式一般健康调查问卷对患者进行评估。
患者（n = 22）分为GPi DBS组（n = 12）和ITB治疗组（n = 10）。对于伯克-法恩-马斯登肌张力障碍评定量表，治疗后DBS组的运动评分和ITB组的残疾评分均显著改善。尽管两组间视觉模拟量表无差异，但自评改善评分在两组间有显著差异。对于生活质量，与术前相比，ITB组在治疗后12个月时身体功能、身体疼痛、活力、社会功能和心理健康均显著改善。两组间仅心理健康有显著差异。
尽管本研究为回顾性设计且病例数相对较少，但表明与GPi DBS相比，ITB治疗侵入性较小且在改善生活质量方面更有效。ITB治疗应被视为重度CP患者的一种替代治疗方法。
