背景:据报道,深部脑刺激(DBS)是严重迟发性肌张力障碍(TD)的运动功能障碍的治疗选择。主要的精神疾病,然而,是TD患者DBS治疗的禁忌症。
方法:六个严重,在两个时间点回顾性研究药物难治性TD患者行双侧前囊切开术联合双侧丘脑下核(STN)-DBS治疗:术前,术后1-3年。使用Burke-Fahn-Marsden肌张力障碍量表(BFMDRS)评估肌张力障碍和残疾。抑郁,焦虑,精神症状,和生活质量(QoL)使用17项汉密尔顿抑郁量表(HAMD-17)进行评估,14项汉密尔顿焦虑量表(HAMA-14),阳性和阴性综合征量表(PANSS),和36项短期健康调查(SF-36),分别。
结果:接受联合治疗25±11.6个月后(范围,12-41个月),据报道,TD患者的临床症状有显著改善.BFMDRS运动和残疾评分分别改善了78.5±32.0%(p=0.031)和76.5±38.6%(p=0.031),分别。HAMD-17和HAMA-14评分分别降低了60.3±27.9%(p=0.007)和60.0±24.6%(p=0.009),分别。此外,共病精神分裂症患者的PANSS评分下降了58.1±6.0%(p=0.022),QoL提高了59.7±14.1%(SF-36,p=0.0001)。在研究过程中,没有明显的不良影响或问题。
结论:双侧前囊切开术联合双侧STN-DBS可能是治疗严重TD合并症和主要精神疾病的有效且相对安全的治疗选择。
BACKGROUND: Deep brain stimulation (DBS) has been reported as a therapy option for the motor dysfunction of severe tardive dystonia (TD). The major psychiatric diseases, however, are contraindications to DBS treatment in TD patients.
METHODS: Six severe, medically refractory TD patients undergoing bilateral anterior capsulotomy combined with bilateral subthalamic nucleus (STN)-DBS treatment were studied retrospectively at two time points: pre-operation, and 1-3 years post-operation. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to assess the dystonia and disability. Depressive, anxiety, psychiatric symptoms, and Quality of Life (QoL) were evaluated using the 17-item Hamilton Depression Scale (HAMD-17), the 14-item Hamilton Anxiety Scale (HAMA-14), the Positive and Negative Syndrome Scale (PANSS), and 36-item Short-Form Health Survey (SF-36), respectively.
RESULTS: After receiving the combination treatment for 25 ± 11.6 months (range, 12-41 months), significant clinical symptom improvements were reported in TD patients. BFMDRS motor and disability scores were ameliorated by 78.5 ± 32.0% (p = 0.031) and 76.5 ± 38.6% (p = 0.031), respectively. The HAMD-17 and HAMA-14 scores were reduced by 60.3 ± 27.9% (p = 0.007) and 60.0 ± 24.6% (p = 0.009), respectively. Furthermore, the PANSS scores of the comorbidity schizophrenia TD patients decreased by 58.1 ± 6.0% (p = 0.022), and the QoL improved by 59.7 ± 14.1% (SF-36, p = 0.0001). During the research, there were no notable adverse effects or problems.
CONCLUSIONS: Bilateral anterior capsulotomy combined with bilateral STN-DBS may be an effective and relatively safe treatment option for severe TD comorbid with major psychiatric disorders.