Clinical Application Of GPi-DBS In The Treatment Of Dystonia Patients

Objective(s):To study the application of DBS in the treatment of dystonia,we retrospectively analyzed 9 patients with dystonia who underwent DBS surgery in the Department of Minimally invasive Neurosurgery,Chenggong Hospital.By analysis the clinical data on postoperative program control and follow-up 3 to 12 month,in order to summarize the operation experience,observation on GPi-DBS surgery for patients with symptoms improve.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 postoperative improvement rate of different types of dystonia.Methods:Patients and grouping criteria:The clinical data of 9 dystonia patients who received DBS treatment in the Department of Minimally invasive Neurosurgery,Chenggong Hospital,the First Affiliated Hospital of Kunming Medical University from May 2019 to December 2020 were retrospectively analyzed.Inclusion criteria:All the patients met the diagnostic criteria for dystonia the course of disease,and had received drug treatment or botulinum toxin injection treatment before surgery,and the treatment effect was not good.All patients or family members signed an informed consent form.There were 4 males and 5 females,aged 33-69years(average age 52.44±9.49 years).Exclusion criteria:1.Patients who could not cooperate with the study subjectively or objectively;2.Head MRI showed organic lesions;3.Patients with obvious disorder.Retrospective clinical medical record research method,the clinical data of 9 patients with dystonia before and after surgery were analyzed.9 patients were counted on the Burke-Fahn-Marsden dystonia score scale(BFM)before operation,at start-up(that is,1 month after operation),3 months,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.9 patients with dystonia were divided into two groups:Primary and secondary hairstyles according to different causes;Systemic and other 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.Results:17 electrodes were implanted in 17 sides of 9 patients.4 patients completed 1-year follow-up,1 case completed 6-month follow-up,4 cases completed 3-month follow-up,and no patients withdrew or discontinued.1M and preoperative BFM-M and BFM-D scores,p<0.05,indicating that there is a significant difference between preoperative and surgical 3M scores.3 M after surgery and preoperative comparison,p<0.05 indicating that the scores before and after 1 months of surgery are also significantly different.Compared with 1M and 3M,p<0.05,indicating that there are not significant differences between 1 months and 3 months after surgery.Grouping Comparison of the preoperative and postoperative 3M 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 also significant difference between preoperative and postoperative.Comparison of 3M scores between the two groups after operation,p>0.05,there is no significant difference between the two.the systemic and other dystonia were grouped,the whole body comparison of preoperative and postoperative 3M BFM-M and BFM-D scores in patients with systemic type dystonia,p<0.05;and the overall BFM score in patients with other dystonia showed a downward trend,but the preoperative and postoperative 3M scores were compared,p>0.05,the degree of improvement is not significant,suggesting that DBS may have slower relief or limited efficacy forother dystonia.The postoperative 3M exercise scores of the two groups were corrected,p>0.05,there was no significant difference between the two.Conclusion(s):1.The effect of GPi-DBS in the treatment of dystonia is beneficial.2.The postoperative symptoms of patients with primary dystonia with a short course of disease were significantly improved.3.The treatment effect of the original hairstyle secondary dystonia(dyskinesia)and systemic dystonia is more significant than the other type of dystonia.4.GPi-DBS can significantly improve the symptoms of dystonia with few side effects,so it is a safe method for the treatment of dystonia.