[1]孙荣辉,宋健,管江衡,等.脊髓电刺激术治疗遗传性脊髓小脑性共济失调1例报道并文献复习[J].中国临床神经外科杂志,2022,27(07):537-540.[doi:10.13798/j.issn.1009-153X.2022.07.003]
　SUN Rong-hui,SONG Jian,GUAN Jiang-heng,et al.Clinical efficacy of spinal cord stimulation for gait dysfunction in patients with hereditary spinocerebellar ataxia type 6: report of one case and literature review[J].,2022,27(07):537-540.[doi:10.13798/j.issn.1009-153X.2022.07.003]
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脊髓电刺激术治疗遗传性脊髓小脑性共济失调1例报道并文献复习()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
27
期数:
2022年07期
页码:
537-540
栏目:
论著
出版日期:
2022-07-31

文章信息/Info

Title:
Clinical efficacy of spinal cord stimulation for gait dysfunction in patients with hereditary spinocerebellar ataxia type 6: report of one case and literature review
文章编号:
1009-153X(2022)07-0537-04
作者:
孙荣辉; 宋健; 管江衡; 徐国政; 马廉亭
430070 武汉，中国人民解放军中部战区总医院神经外科（孙荣辉、宋健、管江衡、徐国政、马廉亭）
Author(s):
SUN Rong-hui;  SONG Jian;  GUAN Jiang-heng;  XU Guo-zheng;  MA Lian-ting
Department of Neurosurgery, General Hospital of Central Theater Command, PLA, Wuhan 430070, China
关键词:
遗传性脊髓小脑共济失调; 脊髓电刺激术; 步态平衡障碍; 疗效
Keywords:
Hereditary spinocerebellar ataxia type 6;  Spinal cord stimulation;  Disturbances of stance and gait;  Clinical efficacy
分类号:
R742.8;R651.1+1
DOI:
10.13798/j.issn.1009-153X.2022.07.003
文献标志码:
A
摘要:
目的 探讨脊髓电刺激术（SCS）治疗遗传性脊髓小脑共济失调（SCA）步态障碍的有效性及可行性。方法 回顾性分析2021年7月SCS治疗的1例6型遗传性SCA（SCA-6型）的临床资料，并结合文献进行复习。结果 成功实施SCS，电极靶点设置在T9~11硬脊膜外间隙，在神经电生理监测下将电极调整至生理中线处。术后复查胸椎CT并三维重建示电极位置满意，术后2周开机行电刺激，制定个体化调控方案。术后1个月，开机状态下，病人步态不稳及平衡障碍明显改善。术后7个月，Tinetti步态与平衡试验量表评分由术前14分提升到24分；Barthel指数由40分提升至80分。术后1年，Tinetti步态与平衡试验量表评分达到25分，Barthel指数提升至85分。结论 我们探索性地将SCS应用于SCA病人，术后病人步态及平衡障碍显著改善。这为步态障碍病人提供了一种可行的、有效的治疗方式。由于目前国内尚无相关报道，这方面的经验尚少，需进一步开展多中心的临床随机对照研究，验证SCS治疗步态障碍的疗效，并探索最佳靶点位置、刺激参数等，以更好地帮助共济失调病人改善症状。
Abstract:
Objective To observe the therapeutic effect of spinal cord stimulation (SCS) on gait disorders in the patients with hereditary spinocerebellar ataxia type 6 (SCA-6). Methods The clinical data of one patient with SCA-6 who underwent SCS on July 22, 2021 were analyzed retrospectively. The relative literatures were reviewed. Results SCS was successfully performed on the patient.Medtronic electrode was placed at the epidural T9~11 level, and adjusted to the physiological midline under neuroelectrophysiological monitoring during the operation. Surgery was well-tolerated without complications. Postoperative CT scan and 3D reconstruction images of thoracic spine showed that the electrode position was satisfactory. Electrical stimulation was performed at 2 weeks after the operation, and individualized mode of stimulation was designed based on the patient's condition. A clinically meaningful improvement in gait and balance function of the patient was achieved on stimulation condition 1 month after the operation. Seven months after the operation, the Barthel index increased from 40 to 80, and the Tinetti score increased from 14 to 24. One year after the operation, the Tinetti score reached 25, and the Barthel index increased to 85. Conclusions We successfully applied SCS to one SCA patient, and the gait disorders of the patient were significantly improved after the operation. This provides a feasible and effective treatment for gait disorder patients. Since there is currently no relevant report in China, and there is little experience in this area, it is necessary to further conduct multi-center randomized controlled clinical trials to verify the efficacy of SCS for the gait disorders, and to explore the best target location, stimulation parameters, etc., in order to improve the symptoms of ataxia patients.

参考文献/References:

[1]Buckley E, Mazzaà C, McNeill A. A systematic review of the gait characteristics associated with cerebellar ataxia [J]. Gait Posture, 2018, 60: 154-163.
[2]Serrao M, Pierelli F, Ranavolo A, et al. Gait pattern in inherited cerebellar ataxias [J]. Cerebellum (London, England), 2012, 11(1): 194-211.
[3]Ishiguro T, Ishikawa K, Takahashi M, et al. The carboxyterminal fragment of alpha (1A) calcium channel preferentially aggregates in the cytoplasm of human spinocerebellar ataxia type 6 Purkinje cells [J]. Acta Neuropathol, 2010, 119(4): 447-464.
[4]Cabaraux P, Agrawal SK, Cai H, et al. Consensus paper: Ataxic Gait [J]. Cerebellum, 2022. doi: 10.1007/s12311-022-01373-9. Online ahead of print.
[5]Sidiropoulos C, Masani K, Mestre T, et al. Spinal cord stimulation for gait impairment in spinocerebellar ataxia 7 [J]. J Neurol, 2014, 261(3): 570-574.
[6]Samotus O, Parrent A, Jog M. Spinal cord stimulation therapy for gait dysfunction in progressive supranuclear palsy patients [J]. J Neurol, 2021, 268(3): 989-996.
[7]Yamaguchi T. Descending pathways eliciting forelimb stepping in the lateral funiculus: experimental studies with stimulation and lesion of the cervical cord in decerebrate cats [J]. Brain Res, 1986, 379(1): 125-136.
[8]Hassan S, Amer S, Alwaki A, et al. A patient with Parkinson's disease benefits from spinal cord stimulation [J]. J Clin Neurosci, 2013, 20: 1155-1156.
[9]Gerasimenko Y, Roy RR, Edgerton VR. Epidural stimulation: comparison of the spinal circuits that generate and control locomotion in rats, cats and humans [J]. Exp Neurol, 2008, 209, 417-425.
[10]Jilge B, Minassian K, Rattay F, et al. Frequency-dependent selection of alternative spinal pathways with common periodic sensory input [J]. Biol Cybern, 2004, 91: 359-376.
[11]Thevathasan W, Mazzone P, Jha A, et al. Spinal cord stimulation failed to relieve akinesia or restore locomotion in Parkinson disease [J]. Neurology, 2010, 74: 1325-1327.

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备注/Memo

备注/Memo:
（2022-06-20收稿）
通讯作者：宋　健，E-mail：docsongjian@yahoo.com
更新日期/Last Update: 2022-08-31