Factors involved in long-term efficacy of deep brain stimulation of the thalamus for essential tremor
Factors involved in long-term efficacy of deep brain stimulation of the thalamus for essential tremor
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DOI：
10.3171/jns/2008/109/10/0640
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发表时间：
2008-10-01
影响因子：
4.1
通讯作者：
Bakay, Roy A. E.
中科院分区：
文献类型：
--
作者：
Pilitsis, Julie G.;Metman, Leo Verhagen;Bakay, Roy A. E.
Object.虽然腹中间核刺激已被证明是安全和有效的治疗特发性震颤。有一部分患者最终失去了从其刺激中获益。这种现象的可能原因包括耐受性、疾病进展和次优位置。本研究的目的是评估可能导致刺激失败的因素。定义为失去有意义的震颤缓解，和不太令人满意的结果，定义为需要> 3.6 V的电压用于有效震颤控制的导联。作者介绍了27例患者的31导联临床结果，这些患者在腹中间核刺激后震颤控制有效> 1年。所有患者术后Fahn-Tolosa-Marin震颤评定量表的书写和绘画分量表均降低（p < 0.00 1）。平均随访40个月。22例患者继续通过刺激控制震颤。4名患者最终在平均39个月时失去了刺激的有效性。在年龄上没有区别。疾病的持续时间或疾病的严重程度。围手术期因素的检查显示，术中透视证明，次优前后定位在刺激失败的患者中发生的频率明显更高（1）= 0.018）。在结局不太令人满意的患者中，两组人口统计学资料之间没有差异。荧光镜检查再次显示，这些患者的次优定位更常见（p = 0.005）。本研究提供了进一步的证据，证明次优电极导线位置与疾病进展或耐受性相结合可能导致不良的不太令人满意的长期结局。
Object. Although nucleus ventralis intermedius stimulation has been shown to be safe and efficacious in the treatment of essential tremor. there is a subset of patients who eventually lose benefit from their stimulation. Proposed causes for this phenomenon include tolerance, disease progression, and suboptimal location. The goal of this study was to assess the factors that may lead to both stimulation failure. defined as loss of meaningful tremor relief, and less satisfactory outcomes, defined as leads requiring voltages > 3.6 V for effective tremor control.Methods. The authors present their clinical outcomes from 3 1 leads in 27 patients who had effective tremor control for > I year following nucleus ventralis intermedius stimulation. All patients postoperatively had a mean decrease in both the writing, and drawing subscales of the Fahn-Tolosa-Marin Tremor Rating Scale (p < 0.00 1).Results. After a mean follow-up of 40 months. 22 patients Continued to have tremor control with stimulation. Four patients eventually lost efficacy of their stimulation at a mean of 39 months. There was no difference in age. duration of disease, or disease severity between the groups. Examination of perioperative factors revealed that suboptimal anteroposterior positioning as evidenced oil intraoperative fluoroscopy Occurred significantly more frequently in patients with stimulation failure (1) = 0.018). In patients with less satisfactory Outcomes, no difference was seen between group demographics. Fluoroscopy again revealed Suboptimal positioning more frequently in these patients (p = 0.005).Conclusions. This Study provides further evidence that Suboptimal lead position in combination with disease progression or tolerance may result ill less satisfactory long-term Outcomes.