| BackgroundDystonia is one of the most common movement disorders.It is the third largest movement disorder after Parkinson's disease and primary tremor.As an extrapyramidal disease,it is caused by:extrapyramidal diseases caused by uncoordinated or excessive contraction of active and antagonist muscles.The clinical presentation includes:persistent or intermittent intense,torsion-like involuntary movements of the neck,trunk,limbs,and facial muscles,or abnormal posture,et al.The current treatment of dystonia,mainly rely on oral drugs taking and botulinum toxin injection,however,the therapeutic efficacy is often,unsatisfied by both clinical doctors and the patients.Deep brain stimulation(DBS)was first developed in the 1980s.It is a new stratagem for dyskinesia of the central nervous system treatment,and it is becoming more and more prominent therapeutic avenue for treating dystonia.By employ the stereotactic technology,DBS utilize surgery operation to implant electrodes into the corresponding nerve nucleus that innervates movement in the brain.The electrodes produce stimulation on the nerve nucleus to affect the patient's movement.After the operation,frequency,pulse width,etc.to form different stimulation combinations to change the excitability of the nerve nucleus and correct the abnormal circuit so as to mitigate the symptoms of the nervous system and treat the neuropsychiatric disorders.The advantages including adjustability of the target and various parameters can be accurately adjusted the according to the symptoms contributes DBS as a relatively safe,reversible,and adjustable nerve regulation method.In recent years,many doctors have begun to apply it in the treatment of dystonia,and have achieved amazing results.In 2016,our hospital established DBS surgery SOP.The neurology department participates in the whole process,and has done a lot of work in screening patients before surgery and in postoperative program control and follow-up.In order to explore the pros and cons of DBS in treatment of dystonia,evaluate the effect of DBS in treatment of dystonia,and discuss the skills of postoperative program control,here,we present our retrospective study on 65 cases of dystonia patients who received the DBS treatment and post-operational regulation in our hospital.Research purposesTo study the application of DBS in the treatment of dystonia,we retrospectively analyzed 65 patients with dystonia who underwent DBS surgery to compare the postoperative improvement rate of different types of dystonia and different surgical targets(STN of subthalamic nucleus)And GPi on the inside of the globus pallidus,to find which type of dystonia is more suitable for DBS surgery,and surgical target.By analysis the clinical date on postoperative program control and follow-up,we discussed the skills of dystonia program control.Our results provide a basis for neurologists to further grasp the indications for surgery and improve the efficiency of postoperative program control.This study may provide the beneficial guidance for clinical practitioners who provide the medical care for the patient of dystonia.Research methods1.Patients and grouping criteria:65 patients with dystonia who underwent DBS surgery from January 2016 to March 2019 and who were programmed in our center(including 37 patients who were operated and programmed in our hospital and 28 others were Surgery outside the hospital but it was started and programmed in our hospital).Inclusion criteria:All the patients met the diagnostic criteria for dystonia,the course of disease was more than 1 year,and all had received systematic drug treatment or botulinum toxin injection treatment before surgery,and the treatment effect was not good.All patients underwent genetic testing for dystonia before surgery.All patients or family members signed an informed consent form.There were 37 males and 28 females,aged 17-67 years(average age 43±8.2 years).Exclusion criteria:?Patients who could not cooperate with the study subjectively or objectively;?Head MRI showed organic lesions;?Patients with obvious disorder.2.Second,using a single-center,retrospective clinical medical record research method,the clinical data of 65 patients with dystonia before and after surgery were analyzed.This subject is divided into two parts:In the first part,65 patients were counted on the dystonia score scale(Burke-Fahn-)before operation,at start-up(that is,1 month after operation),6 months,and 12 months.In Marsden dystonia rating scale(BFM),the scores of movement scale(Movement scale,BFM-M)and disability scale(BFM-D)are compared,and the differences in the scores at different times are compared.To evaluate the effect of DBS surgery on dystonia.65 patients with dystonia were divided into three groups:? Primary and secondary hairstyles according to different causes;?Systemic and segmental types according to the location of the disease,comparing patients with different types of dystonia in different periods The comparison of the BFM score and the improvement rate summarizes the types of dystonia with the most significant improvement rate.?According to different surgical targets,it is divided into STN group and GPi group.The BFM scores of different target operations are compared to evaluate the different treatment effects of different targets on dystonia.In the second part,45 patients with systemic dystonia in the first part of the experiment were selected for the second part of the follow-up and program control analysis after DBS,and statistical analysis of the program control parameters in different periods.Through the statistical analysis and comparison of the program-controlled parameters of grouping(?primary-systemic and secondary-systemic;?STN-systemic and GPi-systemic),observe the program-controlled time of patients with different types of dystonia and different targets differences in parameters.ResultsFirst part1.6M and preoperative BFM-M and BFM-D scores,p<0.01,indicating that there is a significant difference between preoperative and surgical 6M scores,12M after surgery and preoperative comparison,p<0.01,indicating that the scores before and after 12 months of surgery are also significantly different.Compared with 6M and 12M,p<0.01,indicating that there are also significant differences between 6 months and 12 months after surgery.2.Grouping:Comparison of the preoperative and postoperative 12M BFM-M and BFM-D scores of patients with primary dystonia,p<0.05,indicated a significant difference between preoperative and postoperative scores;and patients with secondary dystonia The BFM exercise score showed a general downward trend,but there was no significant difference between preoperative and postoperative 12M,p>0.05,suggesting that DBS may have slower relief or limited efficacy for secondary dystonia.Comparison of 12M scores between the two groups after operation,t=-4.365,p<0.05,there is also a significant difference between the two,indicated that the improvement in the original dystonia group was more significant;the systemic and segmental dystonia were grouped,the whole body comparison of preoperative and postoperative 12M BFM-M and BFM-D scores in patients with type dystonia,p<0.05;and the overall BFM exercise score in patients with segmental dystonia showed a downward trend,but the preoperative and postoperative 12M scores were compared,p>0.05,the degree of improvement is not significant,suggesting that DBS may have slower relief or limited efficacy for segmental dystonia.The postoperative 12M exercise scores of the two groups were corrected,t=-4.653,p<0.05,there was also a significant difference between the two,indicated that the improvement of the systemic dystonia group was more significant;different targets(STN and GPi)were compared in pairs It was found that the comparison between the preoperative and postoperative 12M BFM-M and BFM-D scores of patients in the STN group was statistically different p<0.05,.The comparison of the preoperative and postoperative 12M scores in the GPi group,p<0.05 suggested that STN-DBS and GPi-DBS have obvious effects on dystonia.By comparing the 12M scores between the two groups,there was no statistical difference between the two,t=-1.437,p>0.05.3.By following up the improvement rate of each group in different periods and we found that the improvement rate of each group has increased significantly over time.Second part1.The comparison between the three parameters at 6 months after operation and the power-on has statistical difference,and the scores were higher than the baseline period.The comparison between the three parameters at 12 months after operation and the power-on was also statistically significant.However,compared with the 6 months after operation and 12 months after operation,the three parameters were not statistically significant,and the parameters were adjusted less.2.In different groups,the comparison of voltage and frequency in different periods is statistically significant(p<0.05),and the contrast of pulse width does not change much,there is no statistical significance(p>0.05).There was no significant difference in the parameters of different target operations(p>0.05).Conclusions1.The effect of DBS in the treatment of dystonia isbenificial,and the effect is more significant as time goes by.2.The treatment effect of the original hair style and systemic dystonia is more significant than the other type of dystonia,the surgery of different targets has good results.The DBS operation has less side effects and no obvious effects on cognition.3.The parameter adjustment range is narrow after 6 months,indicating that the condition is relatively stable after half a year.The original and secondary hairstyles,the program control parameters of the STN group and the GPi group are basically the same showed no obvious difference.4.Special program control methods such as cross electric pulse and frequency conversion stimulation may more suitable for those who have difficulty in program control. |
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