Yamada Kazumichi
Division of Speech-Language-Hearing Therapy, Department of Rehabilitation, Faculty of Health Science, Kumamoto Health Science University.
No Shinkei Geka. 2021 Jul;49(4):770-781. doi: 10.11477/mf.1436204455.
Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements or postures. Currently, dystonia is defined as a network disorder involving the basal ganglia, cerebellum, thalamus, and sensorimotor cortex. Considering that it is refractory to medical therapy, functional neurosurgery is indispensable in the treatment strategy for dystonia. Functional neurosurgery may improve dystonic symptoms by suppressing abnormal neuronal activity in the motor loop network. Deep brain stimulation(DBS)of the globus pallidus internus(GPi)is a useful surgical treatment for genetically defined and primary dystonia involving the axial musculature. Thalamic ventral oral(Vo)nucleus surgery is recommended for cases of peripheral dystonia, such as writer's cramp and other occupational types of dystonia. However, pallidal DBS is less effective in cases of secondary dystonia, with the exception of tardive dystonia. Recent studies have reevaluated that ablation surgery is the last-resort treatment when DBS must be discontinued for certain conditions. Magnetic resonance-guided focused ultrasound(MRgFUS), a novel, incision-free, ablation technique, is currently used for the treatment of focal hand dystonia.
肌张力障碍是一种运动障碍,其特征为持续性或间歇性肌肉收缩,导致异常的、通常为重复性的运动或姿势。目前,肌张力障碍被定义为一种涉及基底神经节、小脑、丘脑和感觉运动皮层的网络障碍。鉴于药物治疗效果不佳,功能神经外科手术在肌张力障碍的治疗策略中不可或缺。功能神经外科手术可通过抑制运动环路网络中的异常神经元活动来改善肌张力障碍症状。内侧苍白球(GPi)的脑深部电刺激(DBS)是一种针对涉及轴性肌肉组织的基因明确的原发性肌张力障碍的有效手术治疗方法。对于周围性肌张力障碍病例,如书写痉挛和其他职业性肌张力障碍,建议进行丘脑腹外侧(Vo)核手术。然而,除迟发性肌张力障碍外,苍白球DBS在继发性肌张力障碍病例中的效果较差。最近的研究重新评估了在某些情况下必须停止DBS时,毁损手术是最后的治疗手段。磁共振引导聚焦超声(MRgFUS)是一种新型的、无切口的毁损技术,目前用于治疗手部局灶性肌张力障碍。