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目的 探讨脑深部电刺激术(DBS)治疗痉挛性斜颈的有效性和安全性,并比较不同靶点DBS的疗效.方法 回顾性纳入2005年2月至2018年2月首都医科大学附属北京天坛医院神经外科采用DBS治疗的14例痉挛性斜颈患者,其中7例采用以丘脑底核(STN)为靶点的DBS(简称STN-DBS),7例采用苍白球内侧部(GPi)为靶点的DBS(简称GPi-DBS).于术前和末次随访时采用多伦多痉挛性斜颈量表(TWSTRS)评估患者症状的变化情况,并评估相关不良反应.结果 14例患者的中位随访时间为24(3～150)个月.14例患者中,11例症状有明显改善,其末次随访时的TWSTRS评分与术前的差异有统计学意义(P =0.003).11例患者的TWSTRS评分中位改善率为69.6％ (46.2％ ～ 83.6％).STN-DBS的中位改善率为69.8％(46.2％～83.6％),GPi-DBS的中位改善率为68.7％ (56.0％ ～74.0％),二者的差异无统计学意义(P=1.000).14例患者中,发生电极断裂1例,异动4例,嘴角抽搐1例,1例发生颈部无力、吞咽困难以及构音障碍.结论 DBS为痉挛性斜颈安全、有效的治疗方式,STN和GPi均为治疗痉挛性斜颈的有效靶点.

Objective To evaluate the safety and efficiency of deep brain stimulation (DBS) in the treatment of spasmodic torticollis (ST) and to compare the difference between the efficiency of STN (subthalamic nucleus)-DBS and GPi (globus pallidus internus)-DBS.Methods Fourteen patients underwent DBS from February 2005 to February 2018 at Neurosurgery Department of Beijing Tiantan Hospital,Capital Medical University and were retrospectively enrolled into our study.Seven cases were treated with STN-DBS and seven cases with GPi-DBS.The effects of stimulation on cervical dystonia were analyzed based on the Toronto Western Spasmodic Torticollis Scale (TWSTRS).The scores were collected at baseline and the latest follow-up.Related side effects were also documented.Results The fourteen patients were followed up for the median of 24 (3-150) months.Eleven out of fourteen patients showed a significant improvement from baseline in TWSTRS (P =0.003).The median improvement rate was 69.6％ (46.2％-83.6％).However,there was no significant difference between STN-DBS and GPi-DBS with the improvement rates of 69.8％ (46.2％-83.6％) and 68.7％ (56.0％-74.0％) respectively (P =1.000).Of all 14 patients,there was 1 case of lead breakage,4 cases of dyskinesia,1 case of face tic and 1 case of dysarthria,dysphagia and neck fatigue.Conclusion DBS seems to be an effective and safe therapy method of ST.Both STN and GPi are effective targets for the treatment of ST.