ORANGECOAST MEMORIAL MEDICAL CENTER April/May 2006:
Hỗn Hợp Chích Botox và Giải Phẫu Ðiều Trị Bệnh Thần Kinh Loạn Trương Lực Cơ Dystonia

DYSTONIA FROM THE BRINK
Although few people, 57 year old Jim Ruetz is an expert on the subject. Until recently, the former health care was virtually immobilized by the condition which, which caused sustained muscle contractions that contorted his body into painfully abnormal postures.
But a revolutionary new procedure performed through the Parkinson’s and Movement Disorders Institute (PMDI) at Orange Coast Memorial restored his health—and his life:
“It all began in 1984 when I experienced an involuntary closing of my eyelids,” recalls Jim, who initially attributed his problem to stress. The condition eventually disappeared—but returned with a vengeance in the mid-90s. “This time, the muscles in my lower face began to contract, giving me a perpetual grimace,” he says.
Jim’s primary care physician diagnosed the problem as dystonia—the third most common movement disorder after Parkinson’s disease and essential tremor. Caused by abnormal electrical signals in the brain, the condition isn’t fatal, but is currently incurable.
Despite medication to control the symptoms, Jim’s condition gradually spread to his neck, vocal cords, shoulders, arms, hands and trunk. As his stamina dwindled, the father of two was forced to resign from his job in 1997. Over the next few years, powerful muscle contractions forced his head back at a painful angle and affected his diaphragm, making it difficult to breathe, swallow and speak. When his wife, Jenine, drove him to his appointments he had to lie down in the back seat during the trip. His speech grew so slurred from muscle contractions that even his mother couldn’t understand him.“Because I could only sit or stand for a few minutes, I spent most of my day lying on a mattress on the fl oor, watching TV or doing book work,” says Jim. “I even had to eat my meals lying down.”
Still hopeful for an answer, Jim consulted with Daniel Truong, M.D. An internationally known neurologist and movement disorders specialist at the Parkinson’s and Movement Disorders Institute at Orange Coast Memorial, Dr. Truong started his patient on a new medication regimen, including Botox injections to relax his muscles. Jim’s condition improved somewhat —but his head continued to be pulled back by muscle contractions.
To correct the problem, Dr. Truong and Memorial-Care neurosurgeon Barry Ceverha, M.D. performed a procedure known as selective peripheral denervation, during which some of the nerves causing the backward motion of the neck were severed.
“It worked,” says Jim. “For the first time in years, my neck was in a natural position.”
Botox injections continued to relieve some of the symptoms of dystonia in the rest of his upper body. But in 2004, he developed immunity to the drug. By that time, a procedure called Deep Brain Stimulation (DBS) had been approved by the Federal Drug Administration to treat patients with severe dystonia. Previously approved for the treatment of Parkinson’s disease and essential tremor, DBS entails the implantation of tiny electrodes in the part of the brain responsible for the faulty electrical activity.
“The electrodes are attached to thin wires, which are threaded under the skin to the chest and connected to an implanted neurostimulator,” explains Dr. Truong. “The device generates and relays pulses to the targeted portion of the brain, blocking the errant electrical activity.” In Oct. 2005, Dr. Truong, Dr. Ceverha and neurologist Karen Frei, M.D. operated on Jim. Assisted by MRI scans and state-ofthe-art brain-mapping technology, the surgical team located the precise place in Jim’s brain generating his symptoms. Following surgery, the PMDI team made monthly programming adjustments in the neurostimulator to ensure optimal results. Today, Jim is ecstatic about the results. “It’s a miracle,” says the Brea resident.
“Now I can sit as long as I want, anywhere I want, take my wife out to dinner and drive.
To celebrate his new freedom, he purchased a car last Christmas. “I’m thrilled to be back on the road to a better quality of life,” he says.
For more information, call 1-800-MEMORIAL.Dystonia O R A N G E C O A S T M E M O R I A L • A p r i l / M a y ‘ 0 6 The Parkinson’s and Movement Disorders Institute at Orange Coast Memorial:
• Provides expert care for patients affected by Parkinson’s disease and other movement disorders.
• Conducts research to expand the medical community’s knowledge of movement disorders.
• Is dedicated to improving the quality of life for patients and their families.
Quick Facts
April/May 2006 OrangeCoastMemorial M E D I C A L C E N T E R
Dystonia: From the Brink
Daniel Truong, M.D., Renee Lee, R.N.

Chú thích: Bs Daniel Trương cùng Bs K.P Frei vừa viết một bài về loạn trương lực cơ Dystonia đăng trong sách Y Khoa Thần Kinh Học Lâm Sàng, Textbook of Clinical Neurology, do nhà Xuất Bản Y Học, 2004. (YDuocNgayNay)

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