| Objective: Cranial-cervical dystonia(CCD)refers to the involvement of dystonia in the craniocervical neck and has a high incidence in adults,mainly including spasmodic torticollis(ST)and Meige Syndrome(MS).The cause of the disease haven’t bee clear yet,and there is a lack of effective radical treatment.Currently,the main objective in clinical practice is to alleviate the symptoms and pain of patients.Drug treatment and botulinum toxin treatment can be considered when the early symptoms are relatively mild,but the former has poor efficacy and is accompanied by obvious side effects,while botulinum toxin injection has good short-term efficacy but it is easy to tolerate recurrence in the later stage.Surgical intervention can significantly improve the symptoms and life of patients with refractory CCD.Currently the main surgical method namely Deep Brain electrical Stimulation(DBS),often chooses globus pallidus internus(GPi)as the target,many studies have shown that its curative effect is exact and stable,but the curative effect and the best stimulation subregion is uncertain,this topic is from the GPi-DBS treatment the clinical curative effect of CCD,and analysis the best stimulation area.Methods:We collected 15 patients with CCD during August 2016 to January 2018 who accepted GPi-DBS surgery on both sides,all patients were clearly diagnosed,and we scored on patients’ movement subscale and the disability subscale,before operation,boot after 1 month and 6 month,according to the Burke--Fahn Marsden dystonia score(BFMDRS),computing symptoms improvement rate(Improvement rate=(preoperativescores-postoperative score)/preoperative score(100%)and found the relationship between the time and improvement rate;In additional,all patients were reexamined with thin-layer head CT 1 month after surgery,fused with preoperative T2 phase MRI and combined with intraoperative microelectrode tracing(MER)results,to evaluate the position of electrode contact and the actual stimulation area,and analyze the correlation between symptom improvement rate and the stimulation area.Results: all 15 patients were successfully operated.Typical electrophysiological signals of GPi core were recorded during the operation.No abnormal side effects were found during the temporary electrical stimulation test.No complications such as hemorrhage,cerebral infarction and infection occurred during the perioperative period.There were no hardware-related complications such as electrode rupture and displacement during the follow-up period.The head CT was reviewed in January and merged with preoperative MRI.The position of the electrode implantation and the planned target were accurate.Successfully,15 patients immediately showed different degrees of symptom improvement.After several follow-up procedures,the symptoms gradually stabilized.The average BFM scores of patients before the operation and 1 and 6 months after operation were: 25.46±14.36,20.93±14.89,10.73±8.22.The scores of 6 months after power-on were significantly lower than those 1 month after power-on.and the score at 1 month after starting up was lower than that before surgery,but the difference was not statistically significant(P > 0.05).The average improvement rate after surgery was 56.13%±14.01% and 77.40%±17.48%.Analysis of the patients’ actual stimulation area showed that the distance from the inner medullary lamina is 0-3.15 mm,and the average is(2.11±2.14)mm.The improvement rate of the patient’s symptoms is inversely proportional to the distance.Conclusion: GPi-DBS has a low risk of CCD surgery and a high rate of symptom relief.The effect of postoperative electrical stimulation increases with time.The inner medullary plate may be the best stimulation area. |
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