Department of Neurology, University of Florida, Center for Movement Disorders & Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA.
Parkinsonism Relat Disord. 2013 Sep;19(9):789-94. doi: 10.1016/j.parkreldis.2013.03.015. Epub 2013 Jun 4.
Essential tremor (ET) is one of the most common movement disorders. Normally ET affects the distal upper extremities, but it can also be accompanied by midline symptoms. Ventralis intermedius (VIM) thalamic deep brain stimulation (DBS) has been shown to be effective in reducing hand tremor, but its effects on head tremor have been inconsistent.
Twenty-nine DBS patients with a diagnosis of ET met inclusion criteria. All implantations targeted VIM. The factors examined included age, gender, disease duration, presence or absence of head tremor, handedness, and the Fahn-Tolosa-Marin rating scale (TRS). This analysis specifically focused on TRS head tremor sub-scores at baseline, 6 months and 12 months post-DBS. Additionally, DBS lead entry angles were examined.
Twenty-three ET patients underwent unilateral DBS and six underwent staged bilateral DBS. At both 6 and 12 months following DBS, stimulation resulted in diminished head tremor (ON vs OFF; p < 0.0001). The most important predictor of head tremor suppression was the entry angle of the DBS lead in the sagittal projection relative to the AC-PC axial plane (AC-PC angle). Head tremor reduction was greater among more vertical AC-PC angles.
A more vertical AC-PC angle of the DBS lead trajectory was associated with improved head tremor suppression. Further studies will be necessary to confirm this potentially important finding.
特发性震颤（ET）是最常见的运动障碍之一。通常情况下，ET 会影响远端上肢，但也可能伴有中线症状。腹侧中间核（VIM）丘脑深部脑刺激（DBS）已被证明可有效减轻手部震颤，但对头部震颤的效果却不一致。
29 名符合 ET 诊断标准的 DBS 患者符合纳入标准。所有植入物均针对 VIM。检查的因素包括年龄、性别、疾病持续时间、是否存在头部震颤、利手以及 Fahn-Tolosa-Marin 评定量表（TRS）。该分析特别关注 DBS 后基线、6 个月和 12 个月时的 TRS 头部震颤子评分。此外，还检查了 DBS 导联的进入角度。
23 名 ET 患者接受了单侧 DBS，6 名患者接受了分期双侧 DBS。在 DBS 后 6 个月和 12 个月时，刺激均导致头部震颤减轻（ON 与 OFF；p<0.0001）。头部震颤抑制的最重要预测因素是 DBS 导联在矢状面相对于前后联合（AC-PC）轴平面的进入角度（AC-PC 角度）。DBS 导联轨迹的 AC-PC 角度越垂直，头部震颤的减少越明显。
DBS 导联轨迹的 AC-PC 角度越垂直，与头部震颤抑制的改善相关。需要进一步的研究来证实这一潜在的重要发现。
