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首页> 外文期刊>Neurosurgical focus >Deep brain stimulation in children and young adults with secondary dystonia: The children's hospital Los Angeles experience
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Deep brain stimulation in children and young adults with secondary dystonia: The children's hospital Los Angeles experience

机译：儿童和青少年的深脑刺激次级肌肌：儿童医院洛杉矶经验

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摘要

Background. Dystonia is a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. It can be classified as primary or secondary. There is no cure for dystonia and the goal of treatment is to provide a better quality of life for the patient. Surgical intervention is considered for patients in whom an adequate trial of medical treatment has failed. Deep brain stimulation (DBS), specifically of the globus pallidus interna (GPi), has been shown to be extremely effective in primary generalized dystonia. There is much less evidence for the use of DBS in patients with secondary dystonia. However, given the large number of patients with secondary dystonia, the significant burden on the patients and their families, and the potential for DBS to improve their functional status and comfort level, it is important to continue to investigate the use of DBS in the realm of secondary dystonia. Object. The objective of this study is to review a series of cases involving patients with secondary dystonia who have been treated with pallidal DBS. Methods. A retrospective review of 9 patients with secondary dystonia who received treatment with DBS between February 2011 and February 2013 was performed. Preoperative and postoperative videos were scored using the Barry-Albright Dystonia Scale (BADS) and Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) by a neurologist specializing in movement disorders. In addition, the patients' families completed a subjective questionnaire to assess the perceived benefit of DBS. Results. The average age at DBS unit implantation was 15.1 years (range 6-20 years). The average time to followup for the BADS evaluation from battery implantation was 3.8 months (median 3 months). The average time to followup for the subjective benefit evaluation was 10.6 months (median 9.5 months). The mean BADS scores improved by 9% from 26.5 to 24 (p = 0.04), and the mean BFMDRS scores improved by 9.3% (p = 0.055). Of note, even in patients with minimal functional improvement, there seemed to be decreased contractures and spasms leading to improved comfort. There were no complications such as infections or hematoma in this case series. In the subjective benefit evaluation, 3 patients' families reported "good" benefit, 4 reported "minimal" benefit, and 1 reported no benefit. Conclusions. These early results of GPi stimulation in a series of 9 patients suggest that DBS is useful in the treatment of secondary generalized dystonia in children and young adults. Objective improvements in BADS and BFMDRS scores are demonstrated in some patients with generalized secondary dystonia but not in others. Larger follow-up studies of DBS for secondary dystonia, focusing on patient age, history, etiology, and patterns of dystonia, are needed to learn which patients will respond best to DBS.
机译：背景。 Dystonia是一种运动障碍，其中非自愿的持续或间歇性肌肉收缩导致扭曲和重复运动，异常姿势或两者。它可以被归类为主或次要。缺陷没有治愈，治疗目标是为患者提供更好的生活质量。对于有足够的医疗审判失败的患者，考虑了手术干预。细粒刺激（DBS），特别是Globus pallidus Interna（GPI），已被证明在原发性广泛性肌瘤中非常有效。患有次生患者使用DBS的证据较少。然而，鉴于大量患有次级障碍的患者，患者及其家庭的重大负担，以及DBS的潜力，以提高其功能状态和舒适程度，重要的是继续调查境界中的DBS的使用继发性肌瘤。目的。本研究的目的是审查一系列涉及患有患有粘性DBS治疗的继发性患者的病例。方法。举行回顾性评论，9患有2011年2月和2013年2月在2013年2月和2013年2月期间接受DBS治疗的患者。通过专门从事运动障碍的神经科医生，使用Barry-albright Dystonia Scale（Barry）和Buke-Fahn-Marsden Dystonia评级规模（BFMDRS）进行术前和术后视频。此外，患者家属完成了一个主观调查问卷，以评估DBS的感知福利。结果。 DBS单位植入的平均年龄为15.1年（范围6-20岁）。从电池植入的不良评估的平均时间是3.8个月（中位数3个月）。主观益处评估的平均时间是10.6个月（中位数9.5个月）。平均不良比26.5至24分的平均不良分数提高了9％（P = 0.04），平均BFMDRS分数得到9.3％（P = 0.055）。注意，即使在官能性改善最小的患者中，似乎仍然减少了挛缩和痉挛，导致舒适性提高。在这种情况下，没有任何并发​​症如感染或血肿。在主观益处评估中，3名患者的家庭报告了“良好”的效益，4例报道了“最小”的效益，1报告没有任何益处。结论。这一系列9例患者GPI刺激的这些早期结果表明，DBS可用于治疗儿童和年轻成年人的继发广义肌淋巴结核。在一些患有一般性继发性患者的患者中表明了不良和BFMDRS分数的客观改善，但不在其他患者中。对患者年龄，患者年龄，历史，病因学和肌瘤模式的患者的较大后续研究是必要的，以了解哪些患者将最佳DBS响应。

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  • 来源
    《Neurosurgical focus》 |2013年第5期|共1页
  • 作者

    OlayaJ.E.; ChristianE.; FermanD.; LucQ.; KriegerM.D.; SangerT.D.; LikerM.A.;

  • 作者单位

    Division of Neurosurgery The Keck School of Medicine at USC University of Southern California;

    Division of Neurosurgery The Keck School of Medicine at USC University of Southern California;

    Division of Child Neurology Children's Hospital Los Angeles The Keck School of Medicine at USC;

    Division of Child Neurology Children's Hospital Los Angeles The Keck School of Medicine at USC;

    Division of Neurosurgery The Keck School of Medicine at USC University of Southern California;

    Division of Child Neurology Children's Hospital Los Angeles The Keck School of Medicine at USC;

    Division of Neurosurgery The Keck School of Medicine at USC University of Southern California;

  • 收录信息
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 外科学;
  • 关键词

    Deep brain stimulation; Pediatric neurosurgery; Secondary dystonia;

    机译：深脑刺激;儿科神经外科;继发性肌瘤;

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