Thalamic short pulse stimulation diminishes adverse effects in essential tremor patients
Thalamic short pulse stimulation diminishes adverse effects in essential tremor patients
复制标题
DOI：
10.1212/wnl.0000000000006033
复制
发表时间：
2018-08-21
期刊：
影响因子：
9.9
通讯作者：
Poetter-Nerger, Monika
中科院分区：
文献类型：
--
作者：
Choe, Chi-un;Hidding, Ute;Poetter-Nerger, Monika
目的探讨丘脑腹侧中间核(VIM)定向电流引导和短脉冲刺激对特发性震颤患者刺激副作用的影响。方法选择8例特发性震颤患者，术后病情稳定(脑深部刺激电极植入3个月后)，在VIM内植入分段触点。采用Fahn-Tolosa-Marin震颤评定量表评估急性刺激时震颤的严重程度。采用国际协作性共济失调评定量表评定小脑功能损害。结果在所有患者中，VIM刺激在相同程度上减少了震颤，而无论脉冲宽度如何，使用能量剂量当量幅度。与常规参数相比，短脉冲刺激可减少刺激引起的上肢共济失调和感觉异常。单极刺激定向转向成功地抑制了震颤，但也引起了共济失调。在单节段刺激条件下，没有发现不良反应的差异。结论这些原则验证结果提供了证据，在减少刺激诱发的副作用的同时，保留震颤患者的震颤抑制效果，丘脑底区的急性短脉冲刺激优于定向引导。证据分类本研究提供了IV类证据，证明对于丘脑DBS震颤患者，急性短脉冲刺激可以减少不良反应，而定向引导不能提供关于不良反应的普遍益处。
ObjectiveTo investigate the effect of directional current steering and short pulse stimulation in the ventral intermediate thalamic nucleus (VIM) on stimulation-induced side effects in patients with essential tremor.MethodsWe recruited 8 patients with essential tremor in a stable postoperative condition (> 3 months after electrode implantation of deep brain stimulation [DBS] electrodes) with segmented contacts implanted in the VIM. Tremor severity on acute stimulation was assessed by the Fahn-Tolosa-Marin Tremor Rating Scale. Cerebellar impairment was evaluated with the International Cooperative Ataxia Rating Scale. Patients rated paresthesia intensity with a visual analog scale.ResultsIn all patients, tremor was reduced to the same extent by VIM stimulation regardless of pulse width using energy dose-equivalent amplitudes. Short pulse stimulation diminished stimulation-induced ataxia of the upper extremities and paresthesia compared with conventional parameters. Directional steering with monopolar stimulation of single segments successfully suppressed tremor but also induced ataxia. No differences in adverse effects were found between single-segment stimulation conditions.ConclusionThese proof-of-principle findings provide evidence that acute short pulse stimulation is superior to directional steering in the subthalamic area to decrease stimulation-induced side effects while preserving tremor suppression effects in patients with tremor.Classification of evidenceThis study provides Class IV evidence that for patients with tremor with thalamic DBS, acute short pulse stimulation reduces adverse effects, while directional steering does not provide a generalizable benefit regarding adverse effects.