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Long-term follow-up of pallidal deep brain stimulation for craniocervical dystonia: is the globus pallidus internus the best target?

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机构: [1]Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing. [2]Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong. [3]Neurosurgery Department, Tianjin Huanhu Hospital, Tianjin [4]Functional Neurosurgery Department, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
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关键词: craniocervical dystonia globus pallidus internus deep brain stimulation segmental dystonia long-term efficacy

摘要:
Craniocervical dystonia (CCD) is a common type of segmental dystonia, which is a disabling disease that has been frequently misdiagnosed. Blepharospasm or cervical dystonia is the most usual symptom initially. Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) has been widely used for treating CCD, its clinical outcome has been primarily evaluated in small-scale studies. This research examines the sustained clinical effectiveness of DBS of the GPi in individuals diagnosed with CCD.The authors report 24 patients (14 women, 10 men) with refractory CCD who underwent DBS of the GPi between 2016 and 2023. The severity and disability of the dystonia were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). The BFMDRS scores were collected preoperatively, 6 months postoperatively, and at the most recent follow-up visit.The mean age at onset was 52.0 ± 11.0 years (range 33-71 years) and the mean disease duration was 63.3 ± 73.3 months (range 7-360 months) (values for continuous variables are expressed as the mean ± SD). The mean follow-up period was 37.5 ± 23.5 months (range 6-84 months). The mean total BFMDRS motor scores at the 3 different time points were 13.3 ± 9.4 preoperatively, 5.0 ± 4.7 (55.3% improvement, p < 0.001) at 6 months, and 4.5 ± 3.6 (56.6% improvement, p < 0.001) at last follow-up. The outcomes were deemed poor in 6 individuals.Inferences drawn from the findings suggest that DBS of the GPi has long-lasting effectiveness and certain limitations in managing refractory CCD. The expected stability of the clinical outcome is not achieved. Patients with specific types of dystonia might consider targets other than GPi for a more precise therapy.

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出版当年[2023]版:
大类 | 2 区 医学
小类 | 2 区 临床神经病学 2 区 外科
最新[2023]版:
大类 | 2 区 医学
小类 | 2 区 临床神经病学 2 区 外科
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出版当年[2022]版:
Q1 SURGERY Q2 CLINICAL NEUROLOGY
最新[2023]版:
Q1 SURGERY Q2 CLINICAL NEUROLOGY

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第一作者机构: [1]Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing.
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