Koyama Hiroshi, Mure Hideo, Morigaki Ryoma, Miyamoto Ryosuke, Miyake Kazuhisa, Matsuda Taku, Fujita Koji, Izumi Yuishin, Kaji Ryuji, Goto Satoshi, Takagi Yasushi
Department of Neurosurgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8503, Japan.
Center for Neuromodulation, Department of Neurosurgery, Kurashiki Heisei Hospital, Kurashiki 710-0826, Japan.
Life (Basel). 2021 May 24;11(6):477. doi: 10.3390/life11060477.
Tardive dystonia (TD) is a side effect of prolonged dopamine receptor antagonist intake. TD can be a chronic disabling movement disorder despite medical treatment. We previously demonstrated successful outcomes in six patients with TD using deep brain stimulation (DBS); however, more patients are needed to better understand the efficacy of DBS for treating TD. We assessed the outcomes of 12 patients with TD who underwent globus pallidus internus (GPi) DBS by extending the follow-up period of previously reported patients and enrolling six additional patients. All patients were refractory to pharmacotherapy and were referred for surgical intervention by movement disorder neurologists. In all patients, DBS electrodes were implanted bilaterally within the GPi under general anesthesia. The mean ages at TD onset and surgery were 39.2 ± 12.3 years and 44.6 ± 12.3 years, respectively. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) performed the preoperative and postoperative evaluations. The average BFMDRS improvement rate at 1 month postoperatively was 75.6 ± 27.6% ( < 0.001). Ten patients were assessed in the long term (78.0 ± 50.4 months after surgery), and the long-term BFMDRS improvement was 78.0 ± 20.4%. Two patients responded poorly to DBS. Both had a longer duration from TD onset to surgery and older age at surgery. A cognitive and psychiatric decline was observed in the oldest patients, while no such decline ware observed in the younger patients. In most patients with TD, GPi-DBS could be a beneficial therapeutic option for long-term relief of TD.
迟发性肌张力障碍（TD）是长期服用多巴胺受体拮抗剂的一种副作用。尽管进行了药物治疗，TD仍可能是一种慢性致残性运动障碍。我们之前证明了6例TD患者使用脑深部电刺激（DBS）取得了成功的治疗效果；然而，需要更多患者来更好地了解DBS治疗TD的疗效。我们通过延长先前报告患者的随访期并额外纳入6例患者，评估了12例接受内侧苍白球（GPi）DBS治疗的TD患者的治疗效果。所有患者药物治疗均无效，由运动障碍神经科医生转介接受手术干预。所有患者均在全身麻醉下双侧将DBS电极植入GPi内。TD发病和手术时的平均年龄分别为39.2±12.3岁和44.6±12.3岁。采用伯克-法恩-马斯登肌张力障碍评定量表（BFMDRS）进行术前和术后评估。术后1个月BFMDRS平均改善率为75.6±27.6%（<0.001）。对10例患者进行了长期评估（术后78.0±50.4个月），长期BFMDRS改善率为78.0±20.4%。2例患者对DBS反应不佳。这2例患者从TD发病到手术的时间更长，手术时年龄更大。年龄最大的患者出现了认知和精神衰退，而年轻患者未观察到这种衰退。在大多数TD患者中，GPi-DBS可能是长期缓解TD的一种有益治疗选择。
