Long-term results of thalamic deep brain stimulation for essential tremor
Long-term results of thalamic deep brain stimulation for essential tremor
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DOI：
10.3171/2009.10.jns09371
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发表时间：
2010-06-01
影响因子：
4.1
通讯作者：
Whiting, Donald
中科院分区：
文献类型：
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作者：
Zhang, Kai;Bhatia, Sanjay;Whiting, Donald
Object.丘脑腹侧中间核（Vim）的脑深部电刺激（DBS）已被证明是有效的治疗原发性震颤（ET）。作者报告了一系列由一名神经外科医生在一家机构治疗的患者的长期随访。34例ET患者接受单侧或双侧Vim DBS。在术前和术后评估Fahn-Tolosa-Marin临床震颤评定量表的震颤和手写成分。记录患者总体满意度和震颤控制的视觉模拟量表评分。记录术后不同时间点的刺激参数。平均随访时间为56.9个月。平均震颤评分从术前的3.27改善到术后的0.64（刺激; p < 0.001），平均手写评分从2.94改善到0.89（p < 0.001）。总体满意度的平均视觉模拟量表评分为8.12，震颤控制评分为1.43。总体而言，震颤改善了80.4%，笔迹改善了69.7%。12例患者在术后57.3个月和90.7个月之间比较了震颤和手写评分，未发现显著变化。比较发作时和术后1-3年、3-5年、5-7年和> 7年的刺激参数显示出显著差异，术后5年内刺激参数逐渐增加。总体硬件相关并发症发生率为23. 5%。Vim的脑深部刺激是治疗ET的有效和安全的方法。长期随访中震颤和书写改善稳定。病人对他们的结果的看法是相当好的。然而，在一些需要改变刺激参数的患者中可能会产生耐受性。(DOI：10.3171/2009.10.JNS09371）
Object. Deep brain stimulation (DBS) of the ventral intermediate nucleus of the thalamus (VIM) has proven to be efficacious in the treatment of essential tremor (ET). The authors report on long-term follow-up of a series of patients treated at 1 institution by 1 neurosurgeon.Methods. Thirty-four patients with ET received unilateral or bilateral VIM DBS. The tremor and handwriting components of the Fahn-Tolosa-Marin clinical tremor rating scale were assessed pre- and postoperatively. Visual analog scale scores for overall patient satisfaction and tremor control were recorded. Stimulation parameters at different intervals after surgery were also recorded.Results. The average follow-up period was 56.9 months. The average tremor score improved from 3.27 preoperatively to 0.64 postoperatively (on stimulation; p < 0.001) and the average handwriting score improved from 2.94 to 0.89 (p < 0.001). The average visual analog scale score for overall satisfaction was 8.12 and for tremor control was 1.43. Overall, there was an 80.4% improvement in tremor and 69.7% improvement in handwriting. In 12 patients both tremor and handwriting scores were compared between 57.3 months and 90.7 months after surgery and no significant changes were discovered. Comparison of stimulation parameters at onset and at 1-3, 3-5, 5-7, and > 7 years after surgery showed significant differences, with a gradual increase in stimulation parameters within 5 years after surgery. The overall hardware-related complication rate was 23.5%.Conclusions. Deep brain stimulation of the VIM is an efficient and safe treatment for ET. Tremor and handwriting improvements in long-term follow-up are stable. The patients' perception of their outcome is quite good. However, tolerance may develop in some patients requiring changes in stimulation parameters. (DOI: 10.3171/2009.10.JNS09371)