Supplementary Material for: Five-Year Follow-Up of 10 Patients Treated with Globus Pallidus Internus Deep Brain Stimulation for Segmental or Multisegmental Dystonia

<i>Introduction:</i> Globus pallidus internus (GPi) deep brain stimulation (DBS) represents a validated, effective, and safe treatment for patients affected by generalized dystonia resistant to conservative treatment. Segmental and multisegmental dystonia have more recently been proposed as further indications for GPi DBS despite the lack of long-term homogenous follow-up. Here we present an original and detailed long-term follow-up (5 years) of a homogeneous population of 11 patients affected by segmental or multisegmental dystonia. <i>Materials and Methods:</i> Ten patients underwent bilateral GPi DBS electrode implantations under a Leksell stereotactic guide, with intraoperative neurophysiological monitoring. The follow-ups at 1, 3 and 5 years were collected using video-BFMDRS for motor and disability scores. The statistical analysis of the results is provided. <i>Results:</i> We reported a statistically significant improvement in motor and disability overall scores until 5 years after treatment. At the last follow-up, even the single motor subitems were statistically improved. <i>Discussion:</i> We observed a continuous and statistically significant improvement in all of the motor subitems and in the overall disability score until the 3-year follow-up. These results did not improve any further but they appeared steady at the last follow-up. We also report a significant improvement in the cranial-cervical subitems. <i>Conclusions:</i> GPi DBS should definitely be considered a safe and effective treatment also for segmental and multisegmental dystonia even in cases of relevant or prevalent cranial-cervical involvement.

## 引言
苍白球内侧部（Globus pallidus internus, GPi）脑深部电刺激（deep brain stimulation, DBS）是经证实的有效且安全的治疗手段，适用于经保守治疗无效的全身性肌张力障碍患者。尽管缺乏长期同质化随访数据，节段性肌张力障碍与多节段肌张力障碍近来也被提出作为GPi-DBS的新增适应证。本研究针对11名罹患节段性或多节段肌张力障碍的同质患者群体，展示了一项原创性、详尽的5年长期随访研究结果。

## 材料与方法
10名患者在Leksell立体定向引导仪辅助下，结合术中神经电生理监测，接受了双侧GPi-DBS电极植入术。研究通过视频版BFMDRS（Video-BFMDRS）量表收集了术后1年、3年及5年的随访数据，以评估运动功能与功能障碍评分。本研究同时给出了结果的统计学分析内容。

## 结果
研究结果显示，直至术后5年，患者的运动功能与整体功能障碍评分均出现统计学意义上的显著改善；在末次随访时，单项运动亚项评分同样得到了统计学显著提升。

## 讨论
本研究观察到，直至术后3年随访时，所有运动亚项及整体功能障碍评分均呈现持续且具有统计学意义的改善；后续评分未再进一步提升，但在末次随访时维持稳定。此外，本研究还记录到颅颈亚项评分出现显著改善。

## 结论
即便患者存在显著或主要的颅颈受累情况，GPi-DBS仍应被视为节段性与多节段肌张力障碍的安全且有效的治疗手段。