原發性Meige綜合征不同靶點腦深部電刺激療效比較

【中圖分類號】 R651 【文獻標志碼】 A 【文章編號】 1672-7770（2025）03-0263-09

Abstract： ObjectiveTo compare the eficacy deep brain stimulation（DBS） with different targets in primary Meige syndrome（PMS）.MethodsThe clinical data 15 patients with PMS underwent DBS treatment targeting diferent sites in the University fromApril 2021 to June 2024 were analyzed retrospectively. The 15 patients with PMS received bilateral subthalamic nucleus（STN） or globus pallidus internus（GPi） DBS surgery. The Burke-Fahn-Marsden Dystonia Rating Scale（BFMDRS） （including motor and disability subscale），Hamilton Anxiety Scale（HAMA），and Hamilton Depression Scale（HAMD）were uniformly used to evaluate and record the preoperative and postoperative muscle tone，limb motor function，and mental status the enrolled patients，as well as to document the related postoperative complications.ResultsThe average improvement rate BFMDRS was 59.23% in15 patients at 3 months after surgery，and 67.87% in 10 patients at 12 months after surgery， respectively. The average improvement rates motor scores between patients who received GPi stimulation and STN stimulation were 65.80% and 71.70% ，respectively，and the stimulation the two targets could effctively improve the symptoms，but without statistical difference（ Pgt;0.05 ）.The scores HAMA scale and HAMD scale were improved to different extent compared with those before operation，and the improvement rate HAMA scale in the STN group was better than that in the GPi group with statistical significance（ Plt;0.05 ）． Conclusions Both DBS targets are safe and eective in improving motor symptoms in patients with Meige syndrome，and there is no significant diffrence between two DBS targets for symptom improvement， and STN-DBS and anxiety symptoms improved better than GPi-DBS.

Key words： Meige syndrome; globus pallidus internus； subthalamic nucleus； deep brainstimulation；anxiety；depression

原發性 Meige 綜合征（primary Meige syndrome，PMS）是一種成人發病的節段性肌張力障礙，其特征為不同程度的眼瞼痙攣和口面頸肌張力障礙，可伴有下面部肌肉、口、舌、咽和頸部肌肉的復雜運動，包括雙眼眼瞼痙攣（blepharospasm，BSP）和口下頜肌張力障礙（oromandibular dystonia，OMD）[1]。發病年齡通常在40～70歲，女性比男性更常見（比例范圍為 。PMS是一種復雜的疾病，包括運動和非運動癥狀，而不僅僅是運動相關的，目前發病機制尚未完全闡明，有研究表明，PMS是一種多因素疾病，由其中一個或多個未知基因及表觀遺傳和環境因素共同達到疾病閾值所引起[2]。PMS最初發病可能僅限于眼肌或口下頜區域，其中最常見的表現為BSP，然后擴散到累及其他肌肉[3。腦深部電刺激（deepbrainstimulate，DBS）是一種治療肌張力障礙的方法，它涉及在大腦特定的核團中植入刺激電極，然后持續地發出電信號，目的是抑制異常放電并調控運動環路[4]。雙側蒼白球內側核 DBS（globuspallidus internus，GPi-DBS）被認為是治療PMS 的一種安全且高效的手段，它能夠增強運動能力和提高生活品質，同時不會帶來認知和情感的不良反應[5]。近期有研究進一步證明了丘腦底核（thesubthalamicnucleus，STN）作為DBS靶點的有效性和安全性，尤其是在改善運動癥狀和藥物依賴性方面表現突出[6]。GPi-DBS在改善運動癥狀和生活質量方面表現出色，且對認知和情感功能影響較小，但是其對非運動癥狀（如焦慮、抑郁）的改善效果有限[7]。相比之下，STN-DBS 在調節運動環路方面具有更高的效率，其潛在機制可能與對基底神經節-丘腦-皮質環路的直接調節有關。……