Department of Neurology, Movement Disorders Center, University of Florida, McKnight Brain Institute, Gainesville, Florida 32610, USA.
J Neurosurg. 2010 Mar;112(3):491-6. doi: 10.3171/2009.7.JNS09150.
Microelectrode recording (MER) and macrostimulation (test stimulation) are used to refine the optimal deep brain stimulation (DBS) lead placement within the operative setting. It is well known that there can be a microlesion effect with microelectrode trajectories and DBS insertion. The aim of this study was to determine the impact of intraoperative MER and lead placement on tremor severity in a cohort of patients with essential tremor.
Consecutive patients with essential tremor undergoing unilateral DBS (ventral intermediate nucleus stimulation) for medication-refractory tremor were evaluated. Tremor severity was measured at 5 time points utilizing a modified Tremor Rating Scale: 1) immediately before MER; 2) immediately after MER; 3) immediately after lead implantation; 4) 6 months after DBS implantation in the off-DBS condition; and 5) 6 months after implantation in the on-DBS condition. To investigate the impact of the MER and DBS lead placement, Wilcoxon signed-rank tests were applied to test changes in tremor severity scores over the surgical course. In addition, a generalized linear mixed model including factors that potentially influenced the impact of the microlesion was also used for analysis.
Nineteen patients were evaluated. Improvement was noted in the total modified Tremor Rating Scale, postural, and action tremor scores (p < 0.05) as a result of MER and DBS lead placement. The improvements observed following lead placement were similar in magnitude to what was observed in the chronically programmed clinic setting parameters at 6 months after lead implantation. Improvement in tremor severity was maintained over time even in the off-DBS condition at 6 months, which was supportive of a prolonged microlesion effect. The number of macrostimulation passes, the number of MER passes, and disease duration were not related to the change in tremor severity score over time.
Immediate improvement in postural and intention tremors may result from MER and DBS lead placement in patients undergoing DBS for essential tremor. This improvement could be a predictor of successful DBS lead placement at 6 months. Clinicians rating patients in the operating room should be aware of these effects and should consider using rating scales before and after lead placement to take these effects into account when evaluating outcome in and out of the operating room.
微电极记录（MER）和宏观刺激（测试刺激）用于在手术环境中精确调整深部脑刺激（DBS）的最佳导联位置。众所周知，微电极轨迹和 DBS 插入可能会产生微小损伤效应。本研究旨在确定术中 MER 和导联放置对原发性震颤患者震颤严重程度的影响。
对接受单侧 DBS（腹侧中间核刺激）治疗药物难治性震颤的原发性震颤连续患者进行评估。震颤严重程度利用改良震颤评定量表在 5 个时间点进行测量：1）MER 前即刻；2）MER 后即刻；3）导联植入后即刻；4）DBS 植入后 6 个月，DBS 关闭状态；5）DBS 植入后 6 个月，DBS 开启状态。为了研究 MER 和 DBS 导联放置的影响，应用 Wilcoxon 符号秩检验测试手术过程中震颤严重程度评分的变化。此外，还应用包括可能影响微损伤影响的因素的广义线性混合模型进行分析。
共评估了 19 例患者。MER 和 DBS 导联放置后，总改良震颤评定量表、姿势震颤和动作震颤评分均有改善（p < 0.05）。导联放置后观察到的改善与植入后 6 个月慢性程控诊所参数观察到的改善程度相似。即使在植入后 6 个月的 DBS 关闭状态下，震颤严重程度的改善仍持续存在，支持长期的微损伤效应。宏观刺激次数、MER 次数和疾病持续时间与震颤严重程度评分随时间的变化无关。
原发性震颤患者接受 DBS 治疗时，MER 和 DBS 导联放置可立即改善姿势和意向性震颤。这种改善可能是 6 个月时 DBS 导联成功放置的预测指标。在手术室中对患者进行评分的临床医生应意识到这些影响，并应考虑在植入前后使用评分量表，以便在手术室内外评估结果时考虑这些影响。
