Kinematic analysis of thalamic versus subthalamic neurostimulation in postural and intention tremor
Kinematic analysis of thalamic versus subthalamic neurostimulation in postural and intention tremor
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DOI：
10.1093/brain/awm077
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发表时间：
2007-06-01
期刊：
影响因子：
14.5
通讯作者：
Volkmann, Jens
中科院分区：
文献类型：
--
作者：
Herzog, Jan;Hamel, Wolfgang;Volkmann, Jens
丘脑深部脑刺激（丘脑 DBS）是治疗医学上难治性特发性震颤和多发性硬化症引起的震颤的既定疗法。在这两种疾病中，运动障碍是由运动性震颤和伴随随意运动的共济失调之间复杂的相互作用造成的。在临床研究中，丘脑 DBS 的疗效已得到彻底评估。然而，神经刺激的最佳解剖目标结构仍然存在争议，并且从未与运动障碍不同方面的客观测量相结合进行分析。在 10 名原发性震颤和 II 型多发性硬化症患者中，我们分析了每次接触四极电极时丘脑 DIBS 对对侧震颤评定量表、加速度测量和伸手抓握运动的运动学测量的影响。这些测量与刺激电极在立体定向空间中的解剖位置以及与术中微记录得出的核边界相关。我们发现刺激接触的立体定向 z 坐标对 TRS、加速测量总功率以及减速和抓握运动目标周期的空间偏差有显着影响。最有效的接触集中在丘脑底区（STA）内，覆盖后未定带和丘系前辐射。该区域内的刺激导致偏侧震颤评分量表平均降低 15.8 分，明显优于丘脑内的刺激（P < 0.05，学生 t 检验）。 STA 刺激导致加速计总功率降低 99%，而丘脑腹侧边缘 (68%) 或丘脑本身 (2.5%) 内的刺激效果明显较差 (P < 0.01)。同时，与丘脑本身的刺激相比，STA 刺激导致震颤频率显着增加，肌电图同步性降低（P < 0.001）。在伸手抓握运动中，STA 刺激将减速期运动路径的空间变异性降低了 28.9%，目标期降低了 58.4%，而丘脑内的刺激效果再次显着降低（P < 0.05），减速期降低了 6.5% 至 21.8%，目标期降低了 1.2% 至 11.3%。对术中微记录的核边界分析证实了解剖学印象，即最有效的电极位于 STA 内。我们的数据表明，丘脑区域的深部脑刺激对特发性震颤和多发性硬化症引起的震颤的震颤和共济失调具有深远的影响。与丘脑本身相比，STA 内的刺激效果更好，支持调节小脑-丘脑投射的概念，从而改善这些症状。
Deep brain stimulation of the thalamus (thalamic DBS) is an established therapy for medically intractable essential tremor and tremor caused by multiple sclerosis. In both disorders, motor disability results from complex interaction between kinetic tremor and accompanying ataxia with voluntary movements. In clinical studies, the efficacy of thalamic DBS has been thoroughly assessed. However, the optimal anatomical target structure for neurostimulation is still debated and has never been analysed in conjunction with objective measurements of the different aspects of motor impairment. In 10 essential tremor and II multiple sclerosis patients, we analysed the effect of thalamic DIBS through each contact of the quadripolar electrode on the contralateral tremor rating scale, accelerometry and kinematic measures of reach-to-grasp-movements. These measures were correlated with the anatomical position of the stimulating electrode in stereotactic space and in relation to nuclear boundaries derived from intraoperative microrecording.We found a significant impact of the stereotactic z-coordinate of stimulation contacts on the TRS, accelerometry total power and spatial deviation in the deceleration and target period of reach-to-grasp-movements. Most effective contacts clustered within the subthalamic area (STA) covering the posterior Zona incerta and prelemniscal radiation. Stimulation within this region led to a mean reduction of the lateralized tremor rating scale by 15.8 points which was significantly superior to stimulation within the thalamus (P < 0.05, student's t-test). STA stimulation resulted in reduction of the accelerometry total power by 99%, whereas stimulation at the ventral thalamic border (68%) or within the thalamus proper (2.5%) was significantly less effective (P < 0.01). Concomitantly, STA stimulation led to a significantly higher increase of tremor frequency and decrease in EMG synchronization compared to stimulation within the thalamus proper (P < 0.001). In reach-to-grasp movements, STA stimulation reduced the spatial variability of the movement path in the deceleration period by 28.9% and in the target period by 58.4%, whereas stimulation within the thalamus was again significantly less effective (P < 0.05), with a reduction in the deceleration period between 6.5 and 21.8% and in the target period between 1.2 and 11.3%. An analysis of the nuclear boundaries from intraoperative microrecording confirmed the anatomical impression that most effective electrodes were located within the STA.Our data demonstrate a profound effect of deep brain stimulation of the thalamic region on tremor and ataxia in essential tremor and tremor caused by multiple sclerosis. The better efficacy of stimulation within the STA compared to thalamus proper favours the concept of a modulation of cerebello-thalamic projections underlying the improvement of these symptoms.