不同靶点脑深部电极植入术治疗Meige综合征的疗效评价

Efficacy of deep brain stimulation at different targets in treatment of Meige syndrome

摘要:

目的 探讨不同靶点脑深部电极植入术（deep brains stimulate，DBS）治疗Meige综合征的疗效。方法 回顾性分析重庆医科大学第一附属医院神经外科自2019年3月至2022年4月行不同靶点DBS治疗的8例患者的临床资料。8例原发性Meige综合征患者分别接受了双侧丘脑底核（subthalamic nucleus，STN）或苍白球内侧部（globus pallidus internus，GPI）脑深部电刺激术。采用肌张力障碍评定量表（Burke-Fahn-Marsden dystonia rating scale，BFMDRS）、汉密尔顿焦虑量表（Hamilton anxiety scale，HAMA）和汉密尔顿抑郁量表（Hamilton depression scale，HAMD）分别对患者术前和术后肌张力、肢体运动功能及精神情况进行评估并记录术后相关并发症。结果 术后12个月8例患者的BFMDRS平均改善率为（77.17±11.63）%，且接受GPI刺激与接受STN刺激患者之间平均运动评分改善率分别是76.49%、77.85%，两个靶点均能有效改善患者症状，差异无统计学意义（P>0.05）。另HAMA量表、HAMD量表各项评分较术前均有不同程度改善。结论 不同靶点的DBS治疗均能有效、安全改善Meige综合征的临床症状，可作为药物、肉毒素局部注射治疗无效情况下的替代性方案。

Abstract:

Objective To investigate the efficacy of deep brain stimulation（DBS） at different targets in the treatment of Meige syndrome.Methods A retrospective analysis was performed for the clinical data of eight patients with Meige syndrome who underwent DBS therapy at different targets in Department of Neurosurgery，The First Affiliated Hospital of Chongqing Medical University，from March 2019 to April 2022. The eight patients with primary Meige syndrome received DBS at bilateral subthalamic nucleus（STN） or bilateral globus pallidus internus（GPI）. Burke-Fahn-Marsden Dystonia Rating Scale（BFMDRS），Hamilton Anxiety Scale（HAMA），and Hamilton Depression Scale（HAMD） were used to evaluate the muscle tension，limb motor function，and mental condition of the patients before and after surgery，and postoperative complications were also recorded.Results At 12 months after surgery，the mean improvement rate of BFMDRS was （77.17±11.63）% for the eight patients，and the mean improvement rate of motor score was 76.49% in the patients receiving GPI stimulation and 77.85% in those receiving STN stimulation（P>0.05），suggesting that DBS at both targets could effectively improve the symptoms of patients without significant differences. In addition，there were varying degrees of improvement in HAMA and HAMD scores after surgery.Conclusion DBS treatment at different targets can effectively and safely improve the clinical symptoms of Meige syndrome and can thus be used as an alternative regimen in case of no response to local injection of drugs and botulinum toxins.