USE OF TWO DBS ELECTRODES TO TREAT POST-TRAUMATIC TREMOR

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目及 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 手术治疗继发于头部创伤或多发性硬化症的致残性、药物难治性震颤已被证明比治疗原发性或帕金森震颤困难。 目前还没有前瞻性盲法研究来评价这些震颤亚型的手术治疗疗效。 我们报告了成功使用2个同侧丘脑DBS电极，一个位于腹中间核/腹口后核边界Vim，一个位于腹口前核/腹口后核边界VO，用于治疗1例继发于头部创伤的严重致残和药物难治性震颤患者。 我们已经在另外2例创伤后震颤患者和1例继发于MS的震颤患者中有效应用了该技术。第2个DBS电极的附加受益机制仍不确定;我们怀疑苍白球和小脑回路的刺激，沿着增加的刺激量，覆盖与第2个刺激器相关的更广泛的躯体特征，支持了观察到的积极作用。这种有前途的技术的安全性，益处和副作用仍然没有完全阐明。我们现在建议严格测试双侧同侧丘脑DBS的临床有效性，并描述该手术治疗难治性创伤后或MS相关震颤的安全性、受益和副作用。 本研究为前瞻性盲法研究，将比较Vim DBS与VO DBS，以及Vim DBS开启- VO DBS开启、VIM DBS开启- VO DBS关闭、Vim DBS关闭- VO DBS开启和Vim DBS关闭- VO DBS关闭四种可能DBS条件中的每一种。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Surgical treatment of disabling, medication refractory tremor secondary to head trauma or multiple sclerosis MS has proven difficult than treatment of essential or parkinsonian tremors. There have been no prospective blinded studies to evaluate efficacy of surgical treatments for these tremor subtypes. We reported successful use of 2 ipsilateral thalamic DBS electrodes one at the ventralis intermedius nucleus/ventralis oralis posterior nucleus border VIM and one at the ventralis oralis anterior nucleus/ventralis oralis posterior nucleus border VO for treatment of 1 patient with severely disabling and medication refractory tremor secondary to head trauma. We have applied this technique effectively in 2 more patients with post-traumatic tremor, and 1 with tremor secondary to MS. Mechanisms for additive benefit from the 2nd DBS electrode remain uncertain; we suspect that stimulation of both pallidal and cerebellar circuits, along with increased volume of stimulation covering wider somatotopy associated with the 2nd stimulator underpin the observed positive effects. The safety, benefits, and side effects of this promising technique remain incompletely elucidated. We now propose to rigorously test clinical effectiveness of dual ipsilateral thalamic DBS, and to characterize safety, benefits and side effects of this procedure for treatment of refractory post-traumatic or MS-related tremors. The study will be prospective, blinded, and will compare VIM DBS to VO DBS, as well as each of the four possible DBS conditions VIM DBS on - VO DBS on, VIM DBS on - VO DBS off, VIM DBS off - VO DBS on, and VIM DBS off - VO DBS off.