[Abstract]
OBJECTIVE Surgical procedures involving deep brain stimulation (DBS) of the globus pallidus internus (GPi) or subthalamic nucleus (STN) are well-established treatments for isolated dystonia. However, selection of the best stimulation target remains a matter of debate. The authors』 objective was to compare the effectiveness of DBS of the GPi and the STN in patients with isolated dystonia.
METHODS In this matched retrospective cohort study, the authors searched an institutional database for data on all patients with isolated dystonia who had undergone bilateral implantation of DBS electrodes in either the GPi or STN in the period from January 30, 2014, to June 30, 2017. Standardized assessments of dystonia and health-related quality of life using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and SF-36 were conducted before and at 1, 6, and 12 months after surgery. No patients were lost to the 6-month follow-up; 5 patients were lost to the 12-month follow-up.
RESULTS Both GPi (14 patients) and STN (16 patients) stimulation produced significant improvement in dystonia and quality of life in all 30 patients found in the database search. At the 1-month follow-up, however, the percentage improvement in the BFMDRS total movement score was significantly (p = 0.01) larger after STN DBS (64%) than after GPi DBS (48%). At the 12-month follow-up, the percentage improvement in the axis subscore was significantly (p = 0.03) larger after GPi DBS (93%) than after STN DBS (83%). Also, the total amount of electrical energy delivered was significantly (p = 0.008) lower with STN DBS than with GPi DBS (124 ± 52 vs 192 ± 65 mJ, respectively).
CONCLUSIONS The GPi and STN are both effective targets in alleviating dystonia and improving quality of life. However, GPi stimulation may be better for patients with axial symptoms. Moreover, STN stimulation may produce a larger clinical response within 1 month after surgery and may have a potential economic advantage in terms of lower battery consumption.
【中文摘要】
目的: 蒼白球（GPi）和丘腦底核（STN）的腦深部電刺激是目前治療肌張力障礙的公認手術。然而，選擇最佳刺激靶點仍是一個爭議問題。本研究目的在於比較肌張力障礙患者GPi和STN腦深部電刺激的療效。
方法: 本研究收集了2014年1月30日至2017年6月30日期間接受雙側GPi（n = 14）和STN（n = 16）刺激的肌張力障礙患者30例。肌張力障礙和生活質量的標準化評估使用Burke-Fahn-Marsden肌張力障礙評定量表（BFMDRS）和醫療結果研究36項短式綜合健康調查（SF-36），分別在在手術前和術後1,6和12個月進行評估。
結果: 30例患者和25例患者分別完成了6個月和12個月隨訪。GPi和STN刺激都產生了顯著的臨床效果。我們發現兩組在刺激後一個月的療效有顯著差異（GPi，48％; STN，64％; P = 0.01），表明stn可能比GPi腦刺激起效更快。同時，我們在比較兩組對於身體不同部位的症狀療效後發現，GPi對頸部和軀幹等軸性症狀的改善更為顯著（GPi，93％；STN，83％; p = 0.03）。同時，在比較兩組總電能消耗量後，發現STN在刺激中輸送的總電能遠低於GPi（GPi，192±65.3; STN，123.9±52.2; p = 0.008），表明stn耗電量低，具有經濟優勢。
結論: GPi和STN腦深部電刺激都是肌張力障礙患者的有效靶點。GPI刺激對於有軸性症狀的患者來說可能療效更好。STN在電池消耗方面具有潛在的經濟優勢並且通常起效更快。