双侧丘脑底核脑深部刺激治疗药物难治性Meige综合征

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-10-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.10.008

Ning Wang, Xiao-song Wang, Yupeng Guo, Zonghui Fu, Guoqiang Chen

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No serious complications such as intracranial hemorrhage, wound infection, allergic reaction or electrical stimulator equipment failure occurred during perioperative period. Ten patients (31.3%) had varying degrees of dyskinesia during postoperative programing, which was improved at a certain level after adjustment of programmed parameters. One patient (3.1%) had psychiatric symptoms after surgery, and the mental symptoms disappeared 3 days after treatment. The postoperative follow-up time was >12 months. The improvement rates (median) of BFMDRS scores at 3, 6, and 12 months after surgery were 76.9%, 81.4%, and 82.8%, respectively. Among them, 18 patients were followed up for >24 months, and the improvement rate (median) was 82.5% at 24 months after surgery. All 32 patients were treated with unipolar stimulation mode, which was changed to double negative stimulation mode in 2 cases due to poor effects. 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引用次数: 0

摘要

目的探讨双侧丘脑底核(STN)深部脑刺激(DBS)治疗难治性梅格综合征(MS)的疗效。方法回顾性分析2014年5月至2017年7月在中国医科大学航空总医院功能神经外科行STN-DBS治疗的32例MS患者。采用Burke-Fahn-Marsden肌张力障碍量表(BFMDRS)评估临床症状改善情况。患者的程序参数也被记录下来。结果32例患者均手术成功。围手术期未发生颅内出血、伤口感染、过敏反应、电刺激设备故障等严重并发症。10例患者(31.3%)在术后编程过程中出现不同程度的运动障碍，经过编程参数的调整，运动障碍在一定程度上得到改善。1例(3.1%)术后出现精神症状，治疗3 d后精神症状消失。术后随访10 ~ 12个月。术后3个月、6个月和12个月BFMDRS评分的改善率(中位数)分别为76.9%、81.4%和82.8%。其中18例患者随访100 ~ 24个月，术后24个月改善率(中位)为82.5%。32例患者均采用单极刺激模式治疗，其中2例因效果不佳改为双负刺激模式。术后12个月刺激电压0.8 ~ 3.4 V，刺激脉宽50 ~ 90 μs，刺激频率100 ~ 175 Hz。32例患者术后3 ~ 12个月程控参数无明显升高或降低。结论STN-DBS对耐药ms患者安全有效，术后规划相对简单，参数变化范围小。关键词:梅格综合征;肌张力障碍;丘脑核;脑深部电刺激;预后

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Deep brain stimulation of bilateral subthalamic nucleus for the treatment of drug-refractory Meige syndrome

Objective To explore the therapeutic effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in the treatment of refractory Meige syndrome (MS). Methods A total of 32 patients with MS who underwent STN-DBS at Department of Functional Neurosurgery, Aviation General Hospital of China Medical University from May 2014 to July 2017 were retrospectively enrolled into this study. The Burke-Fahn-Marsden Dystonia Disorder Scale (BFMDRS) was used to assess the improvement of clinical symptoms. The patient′s programmed parameters were documented as well. Results All 32 patients were successfully operated. No serious complications such as intracranial hemorrhage, wound infection, allergic reaction or electrical stimulator equipment failure occurred during perioperative period. Ten patients (31.3%) had varying degrees of dyskinesia during postoperative programing, which was improved at a certain level after adjustment of programmed parameters. One patient (3.1%) had psychiatric symptoms after surgery, and the mental symptoms disappeared 3 days after treatment. The postoperative follow-up time was >12 months. The improvement rates (median) of BFMDRS scores at 3, 6, and 12 months after surgery were 76.9%, 81.4%, and 82.8%, respectively. Among them, 18 patients were followed up for >24 months, and the improvement rate (median) was 82.5% at 24 months after surgery. All 32 patients were treated with unipolar stimulation mode, which was changed to double negative stimulation mode in 2 cases due to poor effects. The stimulation voltage was 0.8-3.4 V at 12 months postoperatively, the stimulation pulse width was 50-90 μs, and the stimulation frequency was 100-175 Hz. There was no significant increase or decrease in the programmed parameters of 32 patients between 3 and 12 months post operation. Conclusions STN-DBS seems safe and effective for patients with drug-resistant MS. Postoperative programming is relatively easy with parameters varying in a small scope. Key words: Meige syndrome; Dystonia; Subthalamic nucleus; Deep brain stimulation; Prognosis

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.