丘脑深部脑刺激治疗原发性震颤的安全性和有效性：10 年及以上。
The safety and efficacy of thalamic deep brain stimulation in essential tremor: 10 years and beyond.
机构信息
Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, , Houston, Texas, USA.
出版信息
J Neurol Neurosurg Psychiatry. 2014 May;85(5):567-72. doi: 10.1136/jnnp-2013-304943. Epub 2013 Oct 4.
BACKGROUND
Deep brain stimulation (DBS) has proven to be a safe and effective therapy for refractory essential tremor, but information regarding long-term outcomes is lacking.
OBJECTIVES
We aimed to assess the long-term safety and efficacy of DBS in patients with essential tremor.
METHODS
Patients treated with DBS for essential tremor for at least 8 years were evaluated in the 'on' and 'off' state using the Fahn-Tolosa-Marin tremor rating scale, and their medical records were reviewed to assess complications related to this therapy.
RESULTS
We studied 13 patients (7 men): median age at evaluation 79 years (range 47-88), median age at electrode implantation 68 years (range 37-78) and mean time since electrode implantation 132.54±15.3 months (range 114-164). The difference between the 'off' and 'on' state on the motor items of the tremor rating scale was 41.9% (58.62 vs. 34.08, p<0.001) in the non-blinded and 37.2% (56.07 vs. 35.23, p<0.001) in the blinded rating. DBS provided a functional improvement of 31.7% in the 'on' state (15.07 vs. 22.07, p<0.001). A total non-blinded improvement in the tremor rating scale of 39% was observed in the 'on' state (49.15 vs. 80.69, p<0.001). Dysarthria and disequilibrium were common in patients with bilateral stimulation. A DBS-related surgery (electrode revision or internal pulse generator exchange) was necessary on average every 47.9 months to continue with the DBS therapy.
CONCLUSIONS
Thalamic DBS is a safe and effective therapy in patients with essential tremor followed for up to 13 years.
背景
深部脑刺激（DBS）已被证明是治疗难治性特发性震颤的一种安全有效的方法，但长期疗效的数据有限。
目的
评估 DBS 治疗特发性震颤的长期安全性和有效性。
方法
对至少接受 8 年 DBS 治疗的特发性震颤患者进行评估，使用 Fahn-Tolosa-Marin 震颤评定量表在“开”和“关”状态下进行评估，并回顾其病历以评估与该治疗相关的并发症。
结果
我们研究了 13 名患者（7 名男性）：评估时的中位年龄为 79 岁（范围 47-88 岁），电极植入时的中位年龄为 68 岁（范围 37-78 岁），自电极植入以来的平均时间为 132.54±15.3 个月（范围 114-164 个月）。在非盲和盲评估中，震颤评定量表的运动项目中“关”与“开”的差值分别为 41.9%（58.62 与 34.08，p<0.001）和 37.2%（56.07 与 35.23，p<0.001）。DBS 在“开”状态下提供了 31.7%的功能改善（15.07 与 22.07，p<0.001）。在“开”状态下，观察到震颤评定量表总改善率为 39%（49.15 与 80.69，p<0.001）。双侧刺激的患者常出现构音障碍和平衡障碍。平均每 47.9 个月需要进行一次与 DBS 相关的手术（电极修正或内部脉冲发生器更换），以继续 DBS 治疗。
结论
丘脑 DBS 是一种安全有效的治疗方法，对特发性震颤患者的随访时间长达 13 年。
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