Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, Gainesville, Fl, 32610, USA.
J Neurol. 2011 Sep;258(9):1643-8. doi: 10.1007/s00415-011-5986-0. Epub 2011 Mar 27.
Deep brain stimulation (DBS) has become an important option for medication-refractory essential tremor (ET), but may contribute to worsened gait and falling. This study evaluates impaired gait in a cohort of patients treated with DBS with a retrospective review of ET patients before and after DBS implantation. Factors examined included: age, duration of symptoms, pre-morbid gait difficulties/falls, Fahn-Tolosa-Marin tremorrating scale (TRS) scores at baseline, 6 months post-unilateral DBS implantation, and 6 or 12 months post-bilateral implantation. All implantations targeted the nucleus ventralis intermediate (Vim). Thirty-eight patients (25 males, 13 females) were included. Twenty-five patients (65.8%) underwent unilateral DBS implantation and 13 (34.2%) bilateral. The mean age at surgery was 67.1 years ± 11.4 (range 34-81). The mean disease duration was 31 years ± 18.3 (range 6-67). Fifty-eight percent of patients had worsened gait post-operatively. Seventy percent of patients with unilateral Vim DBS experienced gait worsening while 55% of bilateral DBS patients experienced gait worsening. Patients with worsened gait post-DBS had higher baseline pre-operative TRS scores than those without worsened gait (43.1 points ± 8.4 vs. 33.1 points ± 10.1, p = 0.002) (odds ratio 2.5, p = 0.02). Gait/balance may worsen following DBS for medication refractory ET. Higher baseline TRS score may factor into these issues, although a larger prospective study will be required with a control population. The larger percentage of difficulties observed in unilateral versus bilateral cases likely reflected the bias not to proceed to second-sided surgery if gait/balance problems were encountered.
深部脑刺激 (DBS) 已成为治疗药物难治性原发性震颤 (ET) 的重要选择，但可能导致步态恶化和跌倒。本研究通过回顾性分析 DBS 治疗后 ET 患者，评估了接受 DBS 治疗的患者的步态受损情况。检查的因素包括：年龄、症状持续时间、患病前步态困难/跌倒、基线时 Fahn-Tolosa-Marin 震颤评定量表 (TRS) 评分、单侧 DBS 植入后 6 个月和双侧植入后 6 或 12 个月。所有植入物均靶向腹侧中间核 (Vim)。共纳入 38 例患者（25 例男性，13 例女性）。25 例患者（65.8%）行单侧 DBS 植入，13 例患者（34.2%）行双侧 DBS 植入。手术时的平均年龄为 67.1 岁±11.4 岁（范围 34-81 岁）。平均病程为 31 年±18.3 年（范围 6-67 年）。术后 58%的患者步态恶化。70%接受单侧 Vim DBS 的患者出现步态恶化，而 55%接受双侧 DBS 的患者出现步态恶化。术后步态恶化的患者术前基线 TRS 评分高于无步态恶化的患者（43.1 分±8.4 分比 33.1 分±10.1 分，p=0.002）（优势比 2.5，p=0.02）。对于药物难治性 ET，DBS 后步态/平衡可能恶化。较高的基线 TRS 评分可能是导致这些问题的因素之一，尽管需要进行一项具有对照人群的更大规模前瞻性研究。单侧病例中观察到的困难比例高于双侧病例，这可能反映了在出现步态/平衡问题时不进行双侧手术的偏见。
