Bellows Steven, Jankovic Joseph
Parkinson's Disease Center, Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, United States of America.
Clin Park Relat Disord. 2019 Dec 4;2:12-19. doi: 10.1016/j.prdoa.2019.11.005. eCollection 2020.
Treatment of dystonia and tics continues to evolve. In dystonia, while oral agents such as benzodiazepines, baclofen and anticholinergics remain in use, botulinum toxin (BoNT) continues to be regarded as the treatment of choice for focal and segmental dystonia, but new preparations are being studied. While deep brain stimulation (DBS) has typically focused on targeting the globus pallidus internus (GPi) when treating dystonia, more recent research has expanded the targets to include subthalamic nucleus (STN) and other targets. In addition to DBS, thalamotomies continue to show therapeutic benefit in focal hand dystonias. Treatment of tics includes a growing armamentarium of options besides the three FDA-approved drugs, all dopamine receptor blockers (haloperidol, pimozide and aripiprazole). Because of lower risk of adverse effects, dopamine depleters (e.g. tetrabebazine, deutetrabenazine, and valbenazine), along with novel D1 receptor antagonists, are currently studied as treatment alternatives in patients with tics. Practice guidelines for the treatment of tics and Tourette syndrome have been recently updated. Data regarding the use of DBS in treatment of tics remains relatively sparse, but international registries have expanded our understanding of the effect of stimulation at several targets.
肌张力障碍和抽动症的治疗方法不断发展。在肌张力障碍方面，虽然苯二氮䓬类、巴氯芬和抗胆碱能药物等口服制剂仍在使用，但肉毒杆菌毒素（BoNT）仍是局灶性和节段性肌张力障碍的首选治疗方法，不过新的制剂正在研究中。在治疗肌张力障碍时，深部脑刺激（DBS）通常聚焦于靶向内侧苍白球（GPi），但最近的研究已将靶点扩展至包括丘脑底核（STN）及其他靶点。除DBS外，丘脑切开术在治疗局灶性手部肌张力障碍方面仍显示出治疗益处。抽动症的治疗除了三种FDA批准的药物（均为多巴胺受体阻滞剂，即氟哌啶醇、匹莫齐特和阿立哌唑）外，可供选择的药物越来越多。由于不良反应风险较低，目前正在研究多巴胺耗竭剂（如丁苯那嗪、氘代丁苯那嗪和缬苯那嗪）以及新型D1受体拮抗剂作为抽动症患者的替代治疗方法。抽动症和妥瑞氏综合征的治疗实践指南最近已更新。关于DBS用于治疗抽动症的数据仍然相对较少，但国际登记处已拓展了我们对多个靶点刺激效果的认识。
