Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports
Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports
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慢性深部脑刺激治疗多发性硬化症震颤：回顾和病例报告
DOI：
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发表时间：
2003
影响因子：
11
通讯作者：
Andrew J Saykin
中科院分区：
文献类型：
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作者：
H. Wishart;D. Roberts;Robert M. Roth;B. McDonald;D. Coffey;A. C. Mamourian;C. Hartley;L. Flashman;Camilo E. Fadul;Andrew J Saykin
背景资料：脑深部电刺激（DBS）为多发性硬化症难治性震颤的手术治疗提供了丘脑切开术的非消融性替代方案。然而，报告的成果相对较少。目的：对DBS用于多发性硬化症的已发表病例进行系统综述，并介绍另外4例患者。方法：对已发表的报告进行定量和定性审查，并对来自一个中心的病例系列进行描述。结果：在报告的大多数病例（n=75）中，DBS植入的手术靶点是丘脑腹间内侧核。大多数患者的震颤减少和日常功能改善，87.7%的患者术后震颤控制至少有一些持续改善。在各项研究中，对日常功能的影响评估不太一致;在报告相关数据的论文中，76.0%的患者的日常功能得到改善。不良反应与DBS在其他患者人群中报告的不良反应相似。结论：很少有研究回顾使用高度标准化的定量结果的措施，随访期一般为一年或更短，尽管如此，数据表明，慢性DBS往往产生改善震颤控制多发性硬化症。震颤不一定完全停止，有时震颤控制会随着时间的推移而下降，频繁的重新编程似乎是必要的。
Background: Deep brain stimulation (DBS) offers a non-ablative alternative to thalamotomy for the surgical treatment of medically refractory tremor in multiple sclerosis. However, relatively few outcomes have been reported. Objective: To provide a systematic review of the published cases of DBS use in multiple sclerosis and to present four additional patients. Methods: Quantitative and qualitative review of the published reports and description of a case series from one centre. Results: In the majority of reported cases (n=75), the surgical target for DBS implantation was the ventrointeromedial nucleus of the thalamus. Tremor reduction and improvement in daily functioning were achieved in most patients, with 87.7% experiencing at least some sustained improvement in tremor control postsurgery. Effects on daily functioning were less consistently assessed across studies; in papers reporting relevant data, 76.0% of patients experienced improvement in daily functioning. Adverse effects were similar to those reported for DBS in other patient populations. Conclusions: Few of the studies reviewed used highly standardised quantitative outcome measures, and follow up periods were generally one year or less. Nonetheless, the data suggest that chronic DBS often produces improved tremor control in multiple sclerosis. Complete cessation of tremor is not necessarily achieved, there are cases in which tremor control decreases over time, and frequent reprogramming appears to be necessary.