Centre de NeuroImagerie de Recherche, Paris, France.
Brain Stimul. 2013 Mar;6(2):175-9. doi: 10.1016/j.brs.2012.04.009. Epub 2012 May 12.
Cerebello-thalamo-cortical (CTC) pathways dysfunction is involved in pathological oscillations causing tremor in essential tremor (ET). Low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of the cerebellum can effectively modulate the cerebellar output.
As one session of rTMS can induce a brief improvement, we hypothesized that repeated sessions might have a cumulative and potentially long-term therapeutic effect on ET. We assessed, in an open label trial, the efficacy of one-week rTMS treatment on tremor and on the motor-CTC dysfunction in ET patients.
Resting-state fMRI functional connectivity was used as an indicator of CTC network integrity in 11 ET patients and 11 healthy subjects. Resting-state fMRI connectivity was quantified at baseline in patients and control subjects between the cerebellum and the motor network, and between the cerebellum and the default brain network (DBN) taken as control. The fMRI study was repeated in patients after 5 days of bilateral 1 Hz rTMS applied to the posterior cerebellar cortex. Tremor was assessed clinically (Fahn-Tolosa-Marin scale) and quantified using electromyographic and accelerometric recordings at baseline (day 1, before the cerebellar stimulation) and after the end of the cerebellar stimulation period at day 5, day 12 and day 29.
Repeated rTMS over the cerebellum significantly improved total and specific (tremor, drawing, functional disability) scores, and reduced tremor amplitude (P < 0.006). It also re-established the defective information processing in the CTC network (P(Δ|y) > 0.909), but not in the DBN. The effects persisted for 3 weeks after the last session.
Cerebellar stimulation could be an effective treatment option for patients with severe essential tremor.
小脑-丘脑-皮质（CTC）通路功能障碍与引起原发性震颤（ET）震颤的病理性振荡有关。小脑低频（1 Hz）重复经颅磁刺激（rTMS）可有效调节小脑输出。
单次 rTMS 治疗可产生短暂的改善效果，因此我们假设重复治疗可能对 ET 具有累积和潜在的长期治疗作用。我们在一项开放性试验中评估了一周 rTMS 治疗对 ET 患者震颤和运动 CTC 功能障碍的疗效。
静息状态 fMRI 功能连接被用作 11 名 ET 患者和 11 名健康对照者 CTC 网络完整性的指标。在患者和对照组中，在基线时对小脑与运动网络之间以及小脑与默认脑网络（DBN）之间的静息状态 fMRI 连接进行了定量分析，DBN 用作对照。在 5 天的双侧 1 Hz rTMS 施加到小脑后皮质后，对患者进行了 fMRI 研究的重复。震颤通过临床（Fahn-Tolosa-Marin 量表）进行评估，并在基线（小脑刺激前的第 1 天）和小脑刺激期结束后的第 5、12 和 29 天使用肌电图和加速度计记录进行量化。
小脑重复 rTMS 显著改善了总评分和特定评分（震颤、绘图、功能障碍），并降低了震颤幅度（P<0.006）。它还重新建立了 CTC 网络中的信息处理缺陷（P(Δ|y)>0.909），但在 DBN 中没有。在最后一次治疗后 3 周内，效果仍然存在。
小脑刺激可能是治疗严重原发性震颤患者的有效选择。
