病例报告：苍白球深部脑刺激术治疗慢性甲氧氯普胺用药所致迟发性肌张力障碍/运动障碍
Case report: Pallidal deep brain stimulation for treatment of tardive dystonia/dyskinesia secondary to chronic metoclopramide medication.
作者信息
Nagel Johanna M, Ghika Joseph, Runge Joachim, Wolf Marc E, Krauss Joachim K
机构信息
Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
Service de Neurologie, Hôpital du Valais, Sion, Switzerland.
出版信息
Front Neurol. 2023 Jan 12;13:1076713. doi: 10.3389/fneur.2022.1076713. eCollection 2022.
OBJECTIVES
Tardive dystonia/dyskinesia (TDD) occurs as a side effect of anti-dopaminergic drugs, including metoclopramide, and is often refractory to medication. While pallidal deep brain stimulation (DBS) has become an accepted treatment for TDD secondary to neuroleptic medication, there is much less knowledge about its effects on metoclopramide-induced TDD.
METHODS
We present the case of a woman with metoclopramide-induced TDD, whose symptoms were initially misjudged as "functional." After 8 years of ineffective medical treatments, she received bilateral implantation of quadripolar electrodes into the posteroventral lateral globus pallidus internus (GPi).
RESULTS
GPi DBS led to significant symptom reduction [Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor score 24/44 at admission and 7/44 at discharge]. Chronic stimulation led to full recovery from TDD symptoms 9 years after surgery. The BFMDRS motor score decreased to 0.5 (98% improvement).
DISCUSSION
Pallidal DBS may result in sustained improvement of TDD secondary to chronic metoclopramide intake in the long term.
目的
迟发性肌张力障碍/运动障碍（TDD）是包括甲氧氯普胺在内的抗多巴胺能药物的一种副作用，且通常对药物治疗无效。虽然苍白球深部脑刺激（DBS）已成为治疗抗精神病药物所致TDD的一种公认疗法，但对于其对甲氧氯普胺所致TDD的影响了解较少。
方法
我们报告了1例甲氧氯普胺所致TDD的女性病例，其症状最初被误诊为“功能性的”。在经过8年无效的药物治疗后，她接受了双侧四极电极植入腹后外侧内侧苍白球（GPi）。
结果
GPi-DBS使症状显著减轻[入院时伯克-法恩-马斯登肌张力障碍评定量表（BFMDRS）运动评分为24/44，出院时为7/44]。长期刺激导致术后9年TDD症状完全缓解。BFMDRS运动评分降至0.5（改善了98%）。
讨论
长期来看，苍白球DBS可能会使长期服用甲氧氯普胺所致的TDD持续改善。
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