Horisawa Shiro, Kohara Kotaro, Murakami Masato, Fukui Atsushi, Kawamata Takakazu, Taira Takaomi
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
Front Hum Neurosci. 2021 Nov 29;15:768057. doi: 10.3389/fnhum.2021.768057. eCollection 2021.
The field of Forel (FF) is a subthalamic area through which the pallidothalamic tracts originating from the globus pallidus internus (GPi) traverse. The FF was used as a stereotactic surgical target (ablation and stimulation) to treat cervical dystonia in the 1960s and 1970s. Although recent studies have reappraised the ablation and stimulation of the pallidothalamic tract at FF for Parkinson's disease, the efficacy of deep brain stimulation of FF (FF-DBS) for dystonia has not been well investigated. To confirm the efficacy and stimulation-induced adverse effects of FF-DBS, three consecutive patients with medically refractory dystonia who underwent FF-DBS were analyzed (tongue protrusion dystonia, cranio-cervico-axial dystonia, and hemidystonia). Compared to the Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale scores before surgery (23.3 ± 12.7), improvements were observed at 1 week (8.3 ± 5.9), 3 months (5.3 ± 5.9), and 6 months (4.7 ± 4.7, = 0.0282) after surgery. Two patients had stimulation-induced complications, including bradykinesia and postural instability, all well controlled by stimulation adjustments.
Forel 区（FF）是一个丘脑底区域，发自内侧苍白球（GPi）的苍白球丘脑束从中穿过。在20世纪60年代和70年代，FF被用作立体定向手术靶点（毁损和刺激）来治疗颈部肌张力障碍。尽管最近的研究重新评估了针对帕金森病对FF处苍白球丘脑束进行毁损和刺激的效果，但FF脑深部电刺激（FF-DBS）治疗肌张力障碍的疗效尚未得到充分研究。为了证实FF-DBS的疗效及刺激引起的不良反应，对连续3例接受FF-DBS治疗的药物难治性肌张力障碍患者（伸舌肌张力障碍、颅颈轴性肌张力障碍和偏侧肌张力障碍）进行了分析。与术前的伯克-法恩-马尔登肌张力障碍评定量表-运动量表评分（23.3±12.7）相比，术后1周（8.3±5.9）、3个月（5.3±5.9）和6个月（4.7±4.7，P = 0.0282）时均观察到改善。2例患者出现刺激引起的并发症，包括运动迟缓及姿势不稳，通过调整刺激均得到良好控制。
