Siegfried J
Int Rehabil Med. 1980;2(1):31-4. doi: 10.3109/09638288009163952.
Two types of operations can be proposed today in the neurosurgical treatment of spasticity; the destruction of a brain target, a medullary pathway or a nerve root, and electrical stimulation of nervous structures. Striking improvements in voluntary motor control and sensory appreciation were first reported by Cook and Weinstein (1) in 1973, after implantation of a dorsal cord stimulator for intractable back pain in a case of muiltiple scleroris. The favourable effect on spasticity was confirmed later by other groups. Our own experience, with 26 cases tested for a few days with floating electrodes and 11 cases operated on and followed up for more than 3 years, shows that the best results are obtained in cases of medullary spasticity, without complete section of the cord, occurring mainly in multiple sclerosis. Cerebral spasticity did not respond as well. The objective data, measurement of stretch and H-reflexes, support the clinical results. The physiological mechanisms of dorsal cord stimulation on spasticity have not yet been elucidated.
如今，在神经外科治疗痉挛方面可采用两种手术方式：破坏脑靶点、髓质通路或神经根，以及对神经结构进行电刺激。1973年，库克和温斯坦首次报告了在一名多发性硬化症患者中植入脊髓背侧刺激器治疗顽固性背痛后，患者的自主运动控制和感觉功能有了显著改善。其他研究小组后来证实了其对痉挛的良好效果。我们自己的经验是，对26例患者使用漂浮电极进行了几天测试，对11例患者进行了手术并随访了3年多，结果表明，在主要发生于多发性硬化症的髓质痉挛病例中，在未完全切断脊髓的情况下可获得最佳效果。大脑性痉挛的反应则没那么好。拉伸测量和H反射等客观数据支持了临床结果。脊髓背侧刺激对痉挛的生理机制尚未阐明。
