Zirh A, Reich S G, Dougherty P M, Lenz F A
Departments of Neurosurgery and Neurology, Johns Hopkins Hospital, Baltimore MD 21287-7713, USA.
J Neurol Neurosurg Psychiatry. 1999 Jun;66(6):772-5. doi: 10.1136/jnnp.66.6.772.
The effectiveness of high frequency stimulation of the thalamic nucleus ventralis intermedius (Vim-HFS) for treatment of tremor has been studied by blinded assessment. The effectiveness of thalamotomy for essential tremor of the upper extremity by use of a blinded measure of outcome is now reported. Thalamotomy was performed in 21 patients (three operated on bilaterally) with medically intractable, essential tremor. Assessments of function, handwriting/drawing, and tremor amplitude were done before and at 3 and 12 months after surgery. The handwriting/drawing score was rated by a neurologist blinded to patient identity, laterality, and operative status. By comparison with baseline, both the total functional score and the total score from blinded assessment of handwriting/drawing improved significantly at 3 and 12 months after surgery. The two scores were significantly correlated, suggesting that the blinded assessment is a good predictor of a total disability from tremor. Complications after unilateral thalamotomy included transient dysarthria, permanent perioral numbness, and permanent mild disequilibrium in one patient each. Permanent mild dysarthria occurred in two of three patients operated bilaterally. Thus a blinded assessment of outcome establishes that unilateral thalamotomy is an effective, safe procedure for the treatment of essential tremor.
已通过盲法评估研究了丘脑腹中间核高频刺激（Vim-HFS）治疗震颤的有效性。现报告采用盲法评估上肢特发性震颤丘脑切开术的疗效。对21例（3例双侧手术）药物治疗无效的特发性震颤患者实施了丘脑切开术。在手术前、术后3个月和12个月对功能、书写/绘图以及震颤幅度进行评估。书写/绘图评分由一位对患者身份、手术侧别和手术状态不知情的神经科医生给出。与基线相比，术后3个月和12个月时，功能总分以及书写/绘图盲法评估的总分均有显著改善。这两个评分显著相关，表明盲法评估是震颤导致完全残疾的良好预测指标。单侧丘脑切开术后的并发症包括1例患者出现短暂性构音障碍、永久性口周麻木和永久性轻度平衡失调。双侧手术的3例患者中有2例出现永久性轻度构音障碍。因此，对结果的盲法评估证实单侧丘脑切开术是治疗特发性震颤的一种有效、安全的方法。
