Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
J Neurosurg. 2010 Jun;112(6):1271-6. doi: 10.3171/2009.10.JNS09371.
Deep brain stimulation (DBS) of the ventral intermediate nucleus of the thalamus (VIM) has proven to be efficacious in the treatment of essential tremor (ET). The authors report on long-term follow-up of a series of patients treated at 1 institution by 1 neurosurgeon.
Thirty-four patients with ET received unilateral or bilateral VIM DBS. The tremor and handwriting components of the Fahn-Tolosa-Marin clinical tremor rating scale were assessed pre- and postoperatively. Visual analog scale scores for overall patient satisfaction and tremor control were recorded. Stimulation parameters at different intervals after surgery were also recorded.
The average follow-up period was 56.9 months. The average tremor score improved from 3.27 preoperatively to 0.64 postoperatively (on stimulation; p < 0.001) and the average handwriting score improved from 2.94 to 0.89 (p < 0.001). The average visual analog scale score for overall satisfaction was 8.12 and for tremor control was 1.43. Overall, there was an 80.4% improvement in tremor and 69.7% improvement in handwriting. In 12 patients both tremor and handwriting scores were compared between 57.3 months and 90.7 months after surgery and no significant changes were discovered. Comparison of stimulation parameters at onset and at 1-3, 3-5, 5-7, and > 7 years after surgery showed significant differences, with a gradual increase in stimulation parameters within 5 years after surgery. The overall hardware-related complication rate was 23.5%.
Deep brain stimulation of the VIM is an efficient and safe treatment for ET. Tremor and handwriting improvements in long-term follow-up are stable. The patients' perception of their outcome is quite good. However, tolerance may develop in some patients requiring changes in stimulation parameters.
丘脑腹中间核（VIM）的深部脑刺激（DBS）已被证明对原发性震颤（ET）的治疗有效。作者报告了在一个机构由一位神经外科医生对一系列患者进行的长期随访结果。
34 例 ET 患者接受单侧或双侧 VIM-DBS。在术前和术后评估 Fahn-Tolosa-Marin 临床震颤评定量表的震颤和书写成分。记录总体患者满意度和震颤控制的视觉模拟量表评分。还记录了术后不同时间的刺激参数。
平均随访时间为 56.9 个月。震颤评分平均从术前的 3.27 分改善至术后的 0.64 分（在刺激时；p<0.001），书写评分从 2.94 分改善至 0.89 分（p<0.001）。总体满意度的平均视觉模拟量表评分为 8.12，对震颤控制的评分为 1.43。总体而言，震颤改善了 80.4%，书写改善了 69.7%。在 12 例患者中，57.3 个月至 90.7 个月术后的震颤和书写评分进行了比较，没有发现显著差异。手术起始时和术后 1-3 年、3-5 年、5-7 年和>7 年的刺激参数比较显示出显著差异，术后 5 年内刺激参数逐渐增加。硬件相关并发症总发生率为 23.5%。
VIM 的深部脑刺激是治疗 ET 的有效且安全的方法。长期随访中震颤和书写的改善是稳定的。患者对其结果的感知相当好。然而，一些患者可能会因需要改变刺激参数而出现耐受性。
