Kích thích não sâu cho các rối loạn vận động. Xem xét trên 276 bệnh nhân liên tiếp

Angelo Franzini1, Roberto Cordella1, Giuseppe Messina1, Carlo Efisio Marras1, Luigi Michele Romito2,3, Francesco Carella2, Alberto Albanese3,2, Michele Rizzi1, Nardo Nardocci4, Giovanna Zorzi4, Edvin Zekay1, Giovanni Broggi1
1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
2Department of Neurology, Fondazione IRCCS Istituto Neurologico “C. Besta”, Milan, Italy
3Università Cattolica di Milano, Milan, Italy
4Department of Child Neurology, Fondazione IRCCS Istituto Neurologico “C. Besta”, Milan, Italy

Tóm tắt

Mối liên hệ giữa kích thích não sâu vùng Stn và bệnh Parkinson giai đoạn tiến triển, cùng với kích thích não sâu vùng GPi và chứng loạn trương lực cơ gần như được chấp nhận phổ biến bởi các bác sĩ thần kinh và bác sĩ phẫu thuật thần kinh. Tuy nhiên, trong một số điều kiện nhất định, các mục tiêu như vùng thalamus dưới và Zona Incerta có thể được xem xét để tối ưu hóa kết quả và tránh tác dụng phụ. Các khía cạnh tích cực và tiêu cực của các phương pháp điều trị kích thích não sâu hiện nay khẳng định sự cần thiết phải nghiên cứu các mục tiêu mới, các chương trình kích thích mới và các thiết bị mới. Kể từ năm 1993, tại Viện Thần kinh Quốc gia “Carlo Besta” ở Milan, 580 điện cực não sâu đã được cấy ghép vào 332 bệnh nhân. 276 bệnh nhân bị ảnh hưởng bởi các rối loạn vận động. Các mục tiêu kích thích não sâu bao gồm Stn, GPi, Voa, Vop, Vim, CM–pf, cZi, IC. Việc theo dõi lâu dài được báo cáo và liên quan đến mục tiêu đã chọn. Kích thích não sâu đã mang lại một lựa chọn điều trị mới cho bệnh nhân bị rối loạn vận động nghiêm trọng, và trong một số trường hợp đã giải quyết các tình trạng bệnh lý đe dọa tính mạng mà nếu không sẽ dẫn đến cái chết của bệnh nhân, chẳng hạn như trong trạng thái loạn trương lực cơ và chứng hemiballismus sau đột quỵ. Tuy nhiên, sự xuất hiện tiềm tàng của các biến chứng nghiêm trọng vẫn hạn chế việc sử dụng kích thích não sâu rộng rãi hơn. Đến thời điểm hiện tại, việc sử dụng kích thích não sâu trong các rối loạn vận động nghiêm trọng có ảnh hưởng tích cực mặc dù cần thêm nghiên cứu và điều tra để phát hiện các ứng dụng tiềm năng mới, và tinh chỉnh các tiêu chí lựa chọn cho các chỉ định và mục tiêu thực tế. Kinh nghiệm về các mục tiêu khác nhau có thể hữu ích trong việc hướng dẫn và điều chỉnh sự lựa chọn mục tiêu phù hợp với tình trạng lâm sàng cá nhân.

Từ khóa

#kích thích não sâu #rối loạn vận động #bệnh Parkinson #chứng loạn trương lực cơ #biến chứng #nghiên cứu lâm sàng

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