脑深部电刺激 (DBS)
在 DBS 中,通过电极在特定脑区域应用高频率电刺激,抑制过度活跃区域中的神经元电活动。迄今为止,已在文献中报告数名接受 DBS 治疗(以内侧苍白球为靶点)的 Lesch-Nyhan 病 (LND) 患者。[54]Taira T, Kobayashi T, Hori T. Disappearance of self-mutilating behavior in a patient with Lesch-Nyhan syndrome after bilateral chronic stimulation of the globus pallidus internus. Case report. J Neurosurg. 2003 Feb;98(2):414-6.http://www.ncbi.nlm.nih.gov/pubmed/12593632?tool=bestpractice.com[55]Pralong E, Pollo C, Coubes P, et al. Electrophysiological characteristics of limbic and motor globus pallidus internus (GPI) neurons in two cases of Lesch-Nyhan syndrome. Neurophysiol Clin. 2005 Nov-Dec;35(5-6):168-73.http://www.ncbi.nlm.nih.gov/pubmed/16530134?tool=bestpractice.com[56]Cif L, Biolsi B, Gavarini S, et al. Antero-ventral internal pallidum stimulation improves behavioral disorders in Lesch-Nyhan disease. Mov Disord. 2007 Oct 31;22(14):2126-9.http://www.ncbi.nlm.nih.gov/pubmed/17853483?tool=bestpractice.com[57]Piedimonte F, Andreani JC, Piedimonte L, et al. Remarkable clinical improvement with bilateral globus pallidus internus deep brain stimulation in a case of Lesch-Nyhan disease: five-year follow-up. Neuromodulation. 2015 Feb;18(2):118-22.http://www.ncbi.nlm.nih.gov/pubmed/25603976?tool=bestpractice.com[58]Deon LL, Kalichman MA, Booth CL, et al. Pallidal deep-brain stimulation associated with complete remission of self-injurious behaviors in a patient with Lesch-Nyhan syndrome: a case report. J Child Neurol. 2012 Jan;27(1):117-20.http://www.ncbi.nlm.nih.gov/pubmed/21940691?tool=bestpractice.com 研究已证实部分患者的运动功能障碍(甚至自伤行为)得到了显著改善,但此疗效可能不是持续性的,并且发现了并发症。在认为 DBS 治疗对 LND 患者有效和安全之前,需要进行更多研究。
选择性多巴胺受体拮抗剂
由于预料之外的副作用,一项在 LND 患者中采用选择性多巴胺 D1/D5 受体拮抗剂依考匹泮 (ecopipam) 治疗的试验被提前终止。[59]Khasnavis T, Torres RJ, Sommerfeld B, et al. A double-blind, placebo-controlled, crossover trial of the selective dopamine D1 receptor antagonist ecopipam in patients with Lesch-Nyhan disease. Mol Genet Metab. 2016 Jul;118(3):160-6.http://www.ncbi.nlm.nih.gov/pubmed/27179999?tool=bestpractice.com 但是,由于在数量有限的入组患者中,此药似乎可减少大多数的自伤,因此对于 LND 中的自伤行为,依考匹泮可能是一种有用的治疗。 在认定对于 LND 有效和安全之前,需要进行进一步的研究。