Department of Neurology, University of São Paulo, São Paulo, Brazil.
Department of Functional Neurosurgery, NEMOD Research Group, Universidad Autónoma de Bucaramanga, Division of Functional Neurosurgery, FOSCAL Hospital, Bucaramanga, Colombia.
Neurosurgery. 2022 Jul 1;91(1):139-145. doi: 10.1227/neu.0000000000001963. Epub 2022 May 16.
Hemidystonia (HD) is characterized by unilateral involuntary torsion movements and fixed postures of the limbs and face. It often develops after deleterious neuroplastic changes secondary to injuries to the brain. This condition usually responds poorly to medical treatment, and deep brain stimulation often yields unsatisfactory results. We propose this study based on encouraging results from case reports of patients with HD treated by ablative procedures in the subthalamic region.
To compare the efficacy of stereotactic-guided radiofrequency lesioning of the subthalamic area vs available medical treatment in patients suffering from acquired HD.
This is an open-label study in patients with secondary HD allocated according to their treatment choice, either surgical or medical treatment; both groups were followed for one year. Patients assigned in the surgical group underwent unilateral campotomy of Forel. The efficacy was assessed using the Unified Dystonia Rating Scale, Fahn-Marsden Dystonia Scale, Arm Dystonia Disability Scale, and SF-36 questionnaire scores.
Patients in the surgical group experienced significant improvement in the Unified Dystonia Rating Scale, Fahn-Marsden Dystonia Scale, and Arm Dystonia Disability Scale (39%, 35%, and 15%, respectively) 1 year after the surgery, with positive reflex in quality-of-life measures, such as bodily pain and role-emotional process. Patients kept on medical treatment did not experience significant changes during the follow-up. No infections were recorded, and no neurological adverse events were associated with either intervention.
The unilateral stereotaxy-guided ablation of Forel H1 and H2 fields significantly improved in patients with HD compared with optimized clinical treatment.
偏身肌张力障碍（HD）的特征是单侧肢体和面部不自主扭转运动和固定姿势。它通常在脑损伤后的有害神经重塑变化后发展。这种情况通常对药物治疗反应不佳，深部脑刺激通常效果不佳。我们基于对接受丘脑下区消融手术治疗的 HD 患者的病例报告的令人鼓舞的结果提出了这项研究。
比较立体定向引导的丘脑下区射频消融与现有的药物治疗对获得性 HD 患者的疗效。
这是一项开放标签的研究，纳入了根据治疗选择（手术或药物治疗）分配的继发性 HD 患者，两组均随访 1 年。手术组患者接受单侧 Forel 区切开术。采用统一肌张力障碍评分量表、Fahn-Marsden 肌张力障碍量表、手臂肌张力障碍残疾量表和 SF-36 问卷评分评估疗效。
手术组患者在手术后 1 年时，统一肌张力障碍评分量表、Fahn-Marsden 肌张力障碍量表和手臂肌张力障碍残疾量表分别显著改善（分别为 39%、35%和 15%），生活质量指标如身体疼痛和角色情感过程的正反射。接受药物治疗的患者在随访期间没有显著变化。没有记录到感染，也没有与任何干预措施相关的神经不良事件。
与优化的临床治疗相比，单侧立体定向引导的 Forel H1 和 H2 区消融术显著改善了 HD 患者的病情。
