Abstract：
OBJECTIVE: Patients with coexisting spastic cerebral palsy (CP) and dystonia have limited treatment options. In this study, the authors aimed to evaluate the efficacy of deep brain stimulation (DBS) targeting the superior cerebellar peduncles (SCPs) in adults with CP.
METHODS: Five patients with CP and medically refractory dystonia and spasticity underwent SCP DBS. Assessments included the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), modified Ashworth scale (mAS), and tests of cognition, mental status, and quality of life preoperatively and at 3, 6, and 12 months postoperatively (in both DBS ON and OFF states, double blinded). Active contacts and fiber bundles were examined.
RESULTS: Four patients completed follow-up. The BFMDRS motor score decreased from 74 to 52 at 12 months postoperatively (30%, p = 0.008). The mean mAS score indicated significant spasticity reduction (from 2.9 ± 0.9 to 1.9 ± 0.6 after 12 months, p = 0.0454). Quality of life improved (p < 0.01), while cognition remained unaffected. Active contacts were found within the dentato-rubro-thalamic tract, with variable efficiency in decussating and nondecussating portions.
CONCLUSIONS: In this pilot trial, SCP DBS showed promise as a well-tolerated treatment for CP, improving dystonic symptoms, spasticity, quality of life, and functional capacities. However, caution is needed when interpreting the results given the small sample size and heterogeneous motor outcomes.
METHODS: Five patients with CP and medically refractory dystonia and spasticity underwent SCP DBS. Assessments included the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), modified Ashworth scale (mAS), and tests of cognition, mental status, and quality of life preoperatively and at 3, 6, and 12 months postoperatively (in both DBS ON and OFF states, double blinded). Active contacts and fiber bundles were examined.
RESULTS: Four patients completed follow-up. The BFMDRS motor score decreased from 74 to 52 at 12 months postoperatively (30%, p = 0.008). The mean mAS score indicated significant spasticity reduction (from 2.9 ± 0.9 to 1.9 ± 0.6 after 12 months, p = 0.0454). Quality of life improved (p < 0.01), while cognition remained unaffected. Active contacts were found within the dentato-rubro-thalamic tract, with variable efficiency in decussating and nondecussating portions.
CONCLUSIONS: In this pilot trial, SCP DBS showed promise as a well-tolerated treatment for CP, improving dystonic symptoms, spasticity, quality of life, and functional capacities. However, caution is needed when interpreting the results given the small sample size and heterogeneous motor outcomes.
摘要：
目的：患有痉挛型脑瘫（CP）和肌张力障碍的患者的治疗选择有限。在这项研究中,作者旨在评估针对成人CP患者小脑上小脑(SCP)的脑深部电刺激(DBS)的疗效.
方法：5例CP和药物难治性肌张力障碍和痉挛患者接受SCPDBS治疗。评估包括Burke-Fahn-Marsden肌张力障碍量表（BFMDRS），改良的Ashworth量表(MAS)，和认知测试，精神状态,术前和术后3、6和12个月时的生活质量（在DBSON和OFF状态下，双盲）。检查了有源触点和纤维束。
结果：4例患者完成随访。术后12个月，BFMDRS运动评分从74降至52(30%，p=0.008)。平均mAS评分显示痉挛明显减轻（12个月后从2.9±0.9至1.9±0.6，p=0.0454)。生活质量改善（p<0.01），而认知不受影响。在牙本质-红斑-丘脑道内发现了活跃的接触，在稀释和非稀释部分具有可变的效率。
结论：在这项试点试验中，SCPDBS显示出作为CP耐受性良好的治疗方法的希望，改善肌张力障碍症状，痉挛,生活质量,和功能能力。然而,考虑到小样本量和异质运动结果，在解释结果时需要谨慎。
方法：5例CP和药物难治性肌张力障碍和痉挛患者接受SCPDBS治疗。评估包括Burke-Fahn-Marsden肌张力障碍量表（BFMDRS），改良的Ashworth量表(MAS)，和认知测试，精神状态,术前和术后3、6和12个月时的生活质量（在DBSON和OFF状态下，双盲）。检查了有源触点和纤维束。
结果：4例患者完成随访。术后12个月，BFMDRS运动评分从74降至52(30%，p=0.008)。平均mAS评分显示痉挛明显减轻（12个月后从2.9±0.9至1.9±0.6，p=0.0454)。生活质量改善（p<0.01），而认知不受影响。在牙本质-红斑-丘脑道内发现了活跃的接触，在稀释和非稀释部分具有可变的效率。
结论：在这项试点试验中，SCPDBS显示出作为CP耐受性良好的治疗方法的希望，改善肌张力障碍症状，痉挛,生活质量,和功能能力。然而,考虑到小样本量和异质运动结果，在解释结果时需要谨慎。
