Bittar Richard G, Hyam Jonathan, Nandi Dipankar, Wang ShouYan, Liu Xuguang, Joint Carole, Bain Peter G, Gregory Ralph, Stein John, Aziz Tipu Z
Department of Neurosurgery, Radcliffe Infirmary, Oxford, UK.
J Clin Neurosci. 2005 Aug;12(6):638-42. doi: 10.1016/j.jocn.2004.09.008.
Disabling intractable tremor occurs frequently in patients with multiple sclerosis (MS). There is currently no effective medical treatment available, and the results of surgical intervention have been variable. Thalamotomy has been the mainstay of neurosurgical therapy for intractable MS tremor, however the popularisation of deep brain stimulation (DBS) has led to the adoption of chronic thalamic stimulation in an attempt to ameliorate this condition. With the goal of examining the relative efficacy and adverse effects of these two surgical strategies, we studied twenty carefully selected patients with intractable MS tremor. Thalamotomy was performed in 10 patients, with chronic DBS administered to the remaining 10. Both thalamotomy and thalamic stimulation produced improvements in postural and intention tremor. The mean improvement in postural tremor at 16.2 months following surgery was 78%, compared with a 64% improvement after thalamic stimulation (14.6 month follow-up) (P > 0.05). Intention tremor improved by 72% in the group undergoing thalamotomy, a significantly larger gain than the 36% tremor reduction following DBS (P < 0.05). Early postoperative complications were common in both groups. Permanent complications related to surgery occurred in four patients overall. Following thalamotomy, long-term adverse effects were observed in three patients (30%), and comprised hemiparesis and seizures. Only one patient in the thalamic stimulation group experienced a permanent deficit (monoparesis). We conclude that thalamotomy is a more efficacious surgical treatment for intractable MS tremor, however the higher incidence of persistent neurological deficits in patients receiving lesional surgery may support the use of DBS as the preferred surgical strategy.
致残性顽固性震颤在多发性硬化症（MS）患者中频繁出现。目前尚无有效的药物治疗方法，手术干预的效果也不尽相同。丘脑切开术一直是治疗顽固性MS震颤的神经外科治疗的主要方法，然而，深部脑刺激（DBS）的普及导致了慢性丘脑刺激的采用，试图改善这种情况。为了研究这两种手术策略的相对疗效和不良反应，我们对20例精心挑选的顽固性MS震颤患者进行了研究。10例患者接受了丘脑切开术，其余10例接受了慢性DBS治疗。丘脑切开术和丘脑刺激均改善了姿势性和意向性震颤。术后16.2个月时姿势性震颤的平均改善率为78%，而丘脑刺激后（随访14.6个月）的改善率为64%（P>0.05）。接受丘脑切开术的组中意向性震颤改善了72%，比DBS后震颤减少36%有显著更大的改善（P<0.05）。两组术后早期并发症均很常见。总体上有4例患者出现了与手术相关的永久性并发症。丘脑切开术后，3例患者（30%）出现了长期不良反应，包括偏瘫和癫痫发作。丘脑刺激组中只有1例患者出现永久性缺陷（单瘫）。我们得出结论，丘脑切开术是治疗顽固性MS震颤更有效的手术方法，然而，接受毁损性手术的患者中持续性神经功能缺损的发生率较高，这可能支持将DBS作为首选的手术策略。
