Wastensson Gunilla, Holmberg Björn, Johnels Bo, Barregard Lars
Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden.
Tremor Other Hyperkinet Mov (N Y). 2013 Nov 4;3. doi: 10.7916/D8VM4B0N. eCollection 2013.
Deep brain stimulation (DBS) of the thalamus is a safe and efficient method for treatment of disabling tremor in patient with essential tremor (ET). However, successful tremor suppression after surgery requires careful selection of stimulus parameters. Our aim was to examine the possible use of certain quantitative methods for evaluating the efficacy of thalamic DBS in ET patients in clinical practice, and to compare these methods with traditional clinical tests.
We examined 22 patients using the Essential Tremor Rating Scale (ETRS) and quantitative assessment of tremor with the stimulator both activated and deactivated. We used an accelerometer (CATSYS tremor Pen) for quantitative measurement of postural tremor, and a eurythmokinesimeter (EKM) to evaluate kinetic tremor in a rapid pointing task.
The efficacy of DBS on tremor suppression was prominent irrespective of the method used. The agreement between clinical rating of postural tremor and tremor intensity as measured by the CATSYS tremor pen was relatively high (rs = 0.74). The agreement between kinetic tremor as assessed by the ETRS and the main outcome variable from the EKM test was low (rs = 0.34). The lack of agreement indicates that the EKM test is not comparable with the clinical test.
Quantitative methods, such as the CATSYS tremor pen, could be a useful complement to clinical tremor assessment in evaluating the efficacy of DBS in clinical practice. Future studies should evaluate the precision of these methods and long-term impact on tremor suppression, activities of daily living (ADL) function and quality of life.
丘脑深部脑刺激术（DBS）是治疗特发性震颤（ET）患者致残性震颤的一种安全有效的方法。然而，术后成功抑制震颤需要仔细选择刺激参数。我们的目的是研究在临床实践中使用某些定量方法评估丘脑DBS对ET患者疗效的可能性，并将这些方法与传统临床测试进行比较。
我们使用特发性震颤评定量表（ETRS）对22例患者进行了检查，并在刺激器开启和关闭的情况下对震颤进行了定量评估。我们使用加速度计（CATSYS震颤笔）对姿势性震颤进行定量测量，并使用节奏运动测量仪（EKM）在快速指向任务中评估运动性震颤。
无论使用何种方法，DBS对震颤抑制的效果都很显著。姿势性震颤的临床评分与CATSYS震颤笔测量的震颤强度之间的一致性相对较高（rs = 0.74）。ETRS评估的运动性震颤与EKM测试的主要结果变量之间的一致性较低（rs = 0.34）。缺乏一致性表明EKM测试与临床测试不可比。
诸如CATSYS震颤笔之类的定量方法，在评估临床实践中DBS的疗效时，可能是临床震颤评估的有用补充。未来的研究应评估这些方法的准确性以及对震颤抑制、日常生活活动（ADL）功能和生活质量的长期影响。
