Department of Neurosurgery, The Methodist Hospital, Houston, Texas, USA.
Mov Disord. 2010 Jan 30;25(2):232-8. doi: 10.1002/mds.22935.
We describe the clinical course and postmortem pathological findings in a patient with essential tremor (ET) treated with deep brain stimulation (DBS) for 12 years. This 75 year old woman had a 13-year history of progressive ET prior to implantation of bilateral quadripolar DBS electrodes in the region of her ventral intermediate thalamic nuclei in 1996, producing immediate relief of arm tremor. Histopathological examination of the brain, performed 12 years after the initial implantation, demonstrated electrode catheter tracts rimmed by 20-25 micron fibrous sheaths, with multinucleated giant cells and reactive gliosis. Lymphocytic infiltration was seen by L26 immunoreactivity with CD3 (T cells) staining predominating over CD20 (B cells). Cerebellar axonal spheroids and Purkinje cell loss were found. The minimal foreign body reaction and gliosis around the electrodes 12 years after implantation supports the long-term safety of DBS. The case represents the longest reported follow-up with autopsy examination after DBS and confirmed histological changes associated with ET.
我们描述了一位患有原发性震颤（ET）的患者的临床病程和死后病理发现，该患者接受了 12 年的深部脑刺激（DBS）治疗。这位 75 岁的女性在 1996 年植入双侧四极 DBS 电极之前，已经有 13 年的进行性 ET 病史，植入后立即缓解了手臂震颤。初次植入后 12 年进行的脑活检显示，电极导管被 20-25 微米的纤维鞘所环绕，鞘内有多核巨细胞和反应性神经胶质增生。L26 免疫反应显示 CD3（T 细胞）染色为主的淋巴细胞浸润，而 CD20（B 细胞）染色则较少。还发现了小脑轴突球体和浦肯野细胞丢失。植入后 12 年，电极周围的异物反应和神经胶质增生最小，支持 DBS 的长期安全性。该病例代表了 DBS 后最长的报道随访和尸检检查，并证实了与 ET 相关的组织学变化。
