Nazzaro Jules M, Lyons Kelly E, Pahwa Rajesh
Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA; Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA; Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA.
Handb Clin Neurol. 2013;116:155-66. doi: 10.1016/B978-0-444-53497-2.00013-9.
Essential tremor is the most common tremor disorder and is characterized by a postural and kinetic tremor. Most commonly, the disease involves the upper extremities, although other body parts may be affected. Essential tremor is seen most often in adults and may markedly limit abilities to perform daily activities. Medications often fail to control the tremor adequately. In the past, ventral intermediate nucleus of the thalamus (VIM) thalamotomy was the surgery of choice for medication-resistant patients with disabling tremor. With technological advances, deep brain stimulation (DBS) to the VIM has replaced thalamotomy as the operation of choice for patients with essential tremor, given the heightened risk of permanent neurological deficits associated with ablative surgery. Multiple studies have demonstrated that unilateral VIM DBS has significant short- and long-term benefits for targeted tremor. Unilateral VIM DBS may also improve head and voice tremor, although most commonly bilateral stimulation is required for adequate control. However, bilateral thalamic stimulation is associated with a higher incidence of neurological deficits, particularly speech and gait problems. Investigations of DBS of other brain target areas for essential tremor, such as the posterior subthalamic area and the subthalamic nucleus, are ongoing.
特发性震颤是最常见的震颤疾病，其特征为姿势性和动作性震颤。最常见的是，该疾病累及上肢，不过身体的其他部位也可能受到影响。特发性震颤在成年人中最为常见，可能会显著限制日常活动能力。药物治疗往往无法充分控制震颤。过去，丘脑腹中间核（VIM）丘脑切开术是药物难治性且震颤致残患者的首选手术。随着技术进步，鉴于毁损性手术存在永久性神经功能缺损的风险增加，对VIM进行脑深部电刺激（DBS）已取代丘脑切开术，成为特发性震颤患者的首选手术。多项研究表明，单侧VIM DBS对目标震颤具有显著的短期和长期益处。单侧VIM DBS也可能改善头部和声音震颤，不过通常需要双侧刺激才能充分控制。然而，双侧丘脑刺激与神经功能缺损的发生率较高相关，尤其是言语和步态问题。针对特发性震颤的其他脑靶点区域（如丘脑后下区域和丘脑底核）进行DBS的研究正在进行中。
