摘要目的 观察双侧丘脑底核(STN)脑深部电刺激术(DBS)治疗药物难治性Meige综合征(MS)的效果.方法 回顾性分析2014年5月至2017年7月在中国医科大学航空总医院功能神经外科采用STN-DBS治疗的MS患者的临床资料,共32例.采用Burke-Fahn-Marsden肌张力障碍量表(BFMDRS)评估临床症状的改善情况;记录患者的程控参数.结果 32例患者手术均成功,围手术期均未出现颅内出血、伤口感染、过敏反应等严重并发症.10例(31.3％)患者在术后程控过程中出现不同程度的异动,经调整程控参数后均有一定程度的改善.1例(3.1％)患者术后出现精神症状,经治疗后3d精神症状消失.32例患者术后随访时间均＞12个月.术后3、6、12个月BFMDRS评分改善率的中位数分别为76.9％、81.4％、82.8％.其中有18例患者随访时间＞24个月,术后24个月BFMDRS评分改善率的中位数为82.5％.32例患者术后均首先采用单极刺激模式,其中2例因效果差,改为双负极刺激模式.术后12个月刺激电压为0.8～3.4 V,刺激脉宽为50 ～ 90 μs,刺激频率为100～ 175 Hz.术后3～12个月32例患者的程控参数均无明显增减.结论 STN-DBS治疗药物难治性MS患者安全、有效;术后程控参数变化范围小、程控相对容易.

abstractsObjective To explore the therapeutic effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in the treatment of refractory Meige syndrome (MS).Methods A total of 32 patients with MS who underwent STN-DBS at Department of Functional Neurosurgery,Aviation General Hospital of China Medical University from May 2014 to July 2017 were retrospectively enrolled into this study.The Burke-Fahn-Marsden Dystonia Disorder Scale (BFMDRS) was used to assess the improvement of clinical symptoms.The patient's programmed parameters were documented as well.Results All 32 patients were successfully operated.No serious complications such as intracranial hemorrhage,wound infection,allergic reaction or electrical stimulator equipment failure occurred during perioperative period.Ten patients (31.3％) had varying degrees of dyskinesia during postoperative programing,which was improved at a certain level after adjustment of programmed parameters.One patient (3.1％) had psychiatric symptoms after surgery,and the mental symptoms disappeared 3 days after treatment.The postoperative follow-up time was ＞ 12 months.The improvement rates (median) of BFMDRS scores at 3,6,and 12 months after surgery were 76.9％,81.4％,and 82.8％,respectively.Among them,18 patients were followed up for ＞24 months,and the improvement rate (median) was 82.5％ at 24 months after surgery.All 32 patients were treated with unipolar stimulation mode,which was changed to double negative stimulation mode in 2 cases due to poor effects.The stimulation voltage was 0.8-3.4 V at 12 months postoperatively,the stimulation pulse width was 50-90 μs,and the stimulation frequency was 100-175 Hz.There was no significant increase or decrease in the programmed parameters of 32 patients between 3 and 12 months post operation.Conclusions STN-DBS seems safe and effective for patients with drug-resistant MS.Postoperative programming is relatively easy with parameters varying in a small scope.