Szczakowska Adrianna, Gabryelska Agata, Gawlik-Kotelnicka Oliwia, Strzelecki Dominik
Central Teaching Hospital, Medical University of Lodz, 92-213 Lodz, Poland.
Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland.
J Clin Med. 2023 Feb 27;12(5):1868. doi: 10.3390/jcm12051868.
Tardive dyskinesia (TD) is a phenomenon observed following the predominantly long-term use of dopamine receptor blockers (antipsychotics) widely used in psychiatry. TD is a group of involuntary, irregular hyperkinetic movements, mainly in the muscles of the face, eyelid, lips, tongue, and cheeks, and less frequently in the limbs, neck, pelvis, and trunk. In some patients, TD takes on an extremely severe form, massively disrupting functioning and, moreover, causing stigmatization and suffering. Deep brain stimulation (DBS), a method used, among others, in Parkinson's disease, is also an effective treatment for TD and often becomes a method of last resort, especially in severe, drug-resistant forms. The group of TD patients who have undergone DBS is still very limited. The procedure is relatively new in TD, so the available reliable clinical studies are few and consist mainly of case reports. Unilateral and bilateral stimulation of two sites has proven efficacy in TD treatment. Most authors describe stimulation of the globus pallidus internus (GPi); less frequent descriptions involve the subthalamic nucleus (STN). In the present paper, we provide up-to-date information on the stimulation of both mentioned brain areas. We also compare the efficacy of the two methods by comparing the two available studies that included the largest groups of patients. Although GPi stimulation is more frequently described in literature, our analysis indicates comparable results (reduction of involuntary movements) with STN DBS.
迟发性运动障碍(TD)是一种在精神病学中广泛使用的多巴胺受体阻滞剂(抗精神病药物)长期大量使用后观察到的现象。TD是一组不自主、不规则的运动亢进,主要出现在面部、眼睑、嘴唇、舌头和脸颊的肌肉中,较少出现在四肢、颈部、骨盆和躯干。在一些患者中,TD表现为极其严重的形式,严重扰乱功能,此外还会导致污名化和痛苦。深部脑刺激(DBS)是一种用于治疗帕金森病等疾病的方法,也是治疗TD的有效方法,通常成为最后的手段,尤其是在严重的、耐药的形式中。接受DBS治疗的TD患者群体仍然非常有限。该手术在TD治疗中相对较新,因此现有的可靠临床研究很少,主要是病例报告。单侧和双侧刺激两个部位已被证明对TD治疗有效。大多数作者描述了内侧苍白球(GPi)刺激;较少涉及丘脑底核(STN)。在本文中,我们提供了关于上述两个脑区刺激的最新信息。我们还通过比较两项包含最大患者群体的现有研究来比较这两种方法的疗效。尽管GPi刺激在文献中描述得更频繁,但我们的分析表明,与STN DBS相比,结果相当(减少不自主运动)。