Deep brain stimulation of the VIM thalamic nucleus modifies several features of essential tremor
Deep brain stimulation of the VIM thalamic nucleus modifies several features of essential tremor
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DOI：
10.1212/01.wnl.0000086371.78447.d2
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发表时间：
2003-10-14
期刊：
影响因子：
9.9
通讯作者：
Corcos, DM
中科院分区：
文献类型：
--
作者：
Vaillancourt, DE;Sturman, MM;Corcos, DM
背景：药物干预（例如，β-受体阻滞剂）和丘脑损伤未能改变特发性震颤（ET）的病理生理学，而不仅仅是震颤幅度的降低。丘脑腹侧中间核（Vim）的脑深部电刺激（DBS）成功降低震颤评分。Vim DBS如何改变ET的病理生理特征尚不清楚。目的：探讨Vim DBS对ET神经生理特性的影响。研究方法：手震颤和前臂伸肌和屈肌的肌电图活动记录在6例ET ON-DBS和OFF-DBS患者和6名年龄和性别匹配的对照组。在不同的惯性负荷下评估手震颤。分析了震颤的幅度、频率、规律性和震颤与肌电的相干性。结果：Vim DBS使ET的振幅降低，频率增加，规律性降低，1 ~ 8Hz震颤-肌电相干性降低。在DBS上，与对照组相比，ET患者具有更大的震颤幅度、更低的频率、更有规律性和更大的震颤-EMG相干性。结论：尽管药理学和丘脑病变以前未能改变ET的特征，但Vim DBS改变了ET的多个特征。Vim DBS后ET的变化为临床疗效提供了有力证据。
Background: Pharmacologic interventions (e.g., beta blockers) and thalamic lesions have failed to alter the pathophysiology of essential tremor (ET) beyond a reduction in tremor amplitude. Deep brain stimulation (DBS) of the ventral intermediate (VIM) nucleus of the thalamus successfully reduces tremor rating scores. It is unknown how VIM DBS alters the pathophysiologic characteristics of ET. Objective: To determine the effects of VIM DBS on the neurophysiologic characteristics of ET. Methods: Hand tremor and EMG activity of forearm extensor and flexor muscles were recorded in six patients with ET ON-DBS and OFF-DBS and from six age- and sex-matched control subjects. Hand tremor was assessed across different inertial loads. The amplitude, frequency, regularity, and tremor-EMG coherence were analyzed. Results: VIM DBS reduced the amplitude, increased the frequency, decreased the regularity, and reduced the 1 to 8 Hz tremor-EMG coherence of ET. ON-DBS, patients with ET had greater tremor amplitude, lower frequency, more regularity, and greater tremor-EMG coherence compared to control subjects. Conclusions: Whereas pharmacologic and thalamic lesions have previously failed to change characteristics of ET beyond amplitude reduction, VIM DBS modified multiple features of ET. The changes in ET after VIM DBS provide strong evidence for clinical efficacy.