1 case of brain deep electrostimulation to treat the extraction of profane language syndrome

1Case informationmale, 16 years old, due to head and shoulder involuntary involuntary revulsion for 8 years, aggravated six months of hospitalization, accompanied by restlessness, irritability, inattention, poor academic performance, unwilling to go to schoolBeijing Xuanwu Hospital was diagnosed with the extraction syndrome, given fluoropyritol (4 mg, 2 times/d) and benzoate hydrochloric acid (2mg2/d) and Medoba (0.25mg2/d), the treatment effect was not goodPreoperative Yale Comprehensive Momentum Severty Scale (YGTSS) sports-pumping score of 19 pointspreoperative 1d, 3.0TMRI flat sweep, choose T1, T2 sequence, through the Leksell surgical planning system for pre-surgical planning, the initial target is the inside of the double pale ball abdomenOn the day of the operation, the Leksell stereotactic headframe was installed with a parallel 64 row spiral CT scan, and the MRI and CT images were fused through the Leksell surgical planning system to re-determine the target position and coordinates; Stimulator, full hemp in the wake of the patient, adjust electrode parameters, frequency 130Hz, frequency width 90s, adjust the voltage 1 to 5V, observe the patient no limb feeling numbness, re-vision and other adverse reactions; On the first day after surgery, the symptoms of twitching, the frequency of the stir and the magnitude of the stir were all reduced, no obvious limb rotation was observed, and the damage effect of the target was considered, and the location of the electrode was accurateon the 3rd day after surgery, the pulse width of 90 s, frequency 130Hz, the voltage base parameter 1.2V, so that patients gradually adapt to electrical stimulationYGTSS scores sports-motion stakes of 11On the 3rd day after power-up, a strong mood swing, the disease worsened, the degree of motion increased than the pre-emotional fluctuation, YGTSS score sports motion pumpscore score 15 points, emotional stability after a slight improvement, YGTSS scoring sports motion pumpscore score of about 13 points, no stimulus parameters adjusted, let the patient adapt to electrical stimulation and then follow the parameter adjustment, after 1 month of starting the adjustment parameters for 2.0V, pulse width of 90 s, frequency 130Hz, the symptoms of convulsion significantly reduced, the corners of the mouth can be seen small amount of convulsion, YGTSS score movement convulsion score 8 pointsFollow-up after 3 months of power-up, adjustment parameters are 2.7V, pulse width of 100 s, frequency 130Hz, YGTSS score sports pumpscore score 8 pointsdiscussioncurrently, there is no specific treatment for the extraction syndromeA variety of drug treatment ineffective incurable cases, can be used for surgical treatmentSurgery is commonly used for stereotactic damage or deep brain electrical stimulationThe target point of the damage surgery can choose the inner inner part of the single-sided pale ball abdomen, the front of the double-sided inner sac, the outer nucleus of the one-sided thalamus, the two-sided buckle back, the two-sided amygdala, the two-sided volt nucleus according to the symptom The targets that can be selected for deep brain electrostimulation are the central nucleus/beam side nuclear complex of the thalamus, the inner inner part of the pale ball abdomen, the forelimb of the inner sac and the vulcanic nucleus The choice of targets is mainly based on clinical symptoms There are stalks, abnormal behavior, pronunciation jerking and other manifestations, the choice of the central hypothalamus nuclear / beam side nuclear complex, can improve the quality of life can produce a sustained effect; The case of this paper is mainly to stir, so choose the inner part of the pale ball belly as the stimulation point, and achieve good results some patients may experience or disappear after puberty, as they age, they may lose access to education and some social functions But there is no consensus among experts on the age of surgery In addition, the increase in the height of the patient will increase the tension of the wire, resulting in the wire break, therefore, for adolescent height is not fully developed patients, the length of the wire needs to be reserved in the operation, in order to prevent excessive wire tension Deep brain electrical stimulation has the characteristics of safe, minimally invasive and adjustable, which provides more options for the treatment of the stirring prosthesis syndrome