Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia
Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia
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DOI：
10.1212/wnl.0000000000004295
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发表时间：
2017-09-26
期刊：
影响因子：
9.9
通讯作者：
Moro, Elena
中科院分区：
文献类型：
--
作者：
Cury, Rubens Gisbert;Fraix, Valerie;Moro, Elena
目的：报告丘脑腹侧中间核（Vim）在帕金森病（PD），特发性震颤（ET）和肌张力障碍性tremer.Methods：159例PD，ET和肌张力障碍患者接受Vim DBS由于难治性震颤在格勒诺布尔大学医院的长期结果。主要结局是术后1年和最近随访（21年）时震颤评分的变化。次要结局包括震颤评分随时间的减少与主动接触位置之间的关系。震颤评分（统一帕金森病评定量表-III，第20和21项; Fahn，Tolosa，Marin震颤评定量表）和坐标的活动contacts.Results：98例患者被纳入。PD和ET患者在Vim刺激下震颤持续改善（平均改善，1年分别为70%和66%; 10年后分别为63%和48%; p< 0.05）。随着时间的推移，刺激益处没有显著损失（p> 0.05）。肌张力障碍患者在1年随访时表现出中度缓解（震颤改善41%，p = 0.027），5年后未持续（改善30%，p = 0.109）。右侧电极导线中更多的背侧活动触点坐标与术后1年的更好结局相关（p = 0.029）。在整个随访过程中，48例（49%）出现轻微的副作用，而2例（2.0%）有严重事件（脑出血和感染）。结论：Vim DBS是一种有效的长期（超过10年）治疗震颤PD和ET。对肌张力障碍性震颤的影响是适度和短暂的。
Objective: To report on the long-term outcomes of deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) in Parkinson disease (PD), essential tremor (ET), and dystonic tremor.Methods: One hundred fifty-nine patients with PD, ET, and dystonia underwent VIM DBS due to refractory tremor at the Grenoble University Hospital. The primary outcome was a change in the tremor scores at 1 year after surgery and at the latest follow-up (21 years). Secondary outcomes included the relationship between tremor score reduction over time and the active contact position. Tremor scores (Unified Parkinson's Disease Rating Scale-III, items 20 and 21; Fahn, Tolosa, Marin Tremor Rating Scale) and the coordinates of the active contacts were recorded.Results: Ninety-eight patients were included. Patients with PD and ET had sustained improvement in tremor with VIM stimulation (mean improvement, 70% and 66% at 1 year; 63% and 48% beyond 10 years, respectively; p< 0.05). There was no significant loss of stimulation benefit over time (p> 0.05). Patients with dystonia exhibited a moderate response at 1-year follow-up (41% tremor improvement, p = 0.027), which was not sustained after 5 years (30% improvement, p = 0.109). The more dorsal active contacts' coordinates in the right lead were related to a better outcome 1 year after surgery (p = 0.029). During the whole follow-up, forty-eight patients (49%) experienced minor side effects, whereas 2 (2.0%) had serious events (brain hemorrhage and infection).Conclusions: VIM DBS is an effective long-term (beyond 10 years) treatment for tremor in PD and ET. Effects on dystonic tremor were modest and transient.