Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Mov Disord. 2011 Oct;4(2):64-7. doi: 10.14802/jmd.11013. Epub 2011 Oct 30.
Stereotactic thalamotomy has been an effective surgical procedure in the treatment of medically refractory essential tremor (ET), however, little is known about the bilateral effects of unilateral ventralis intermedius (Vim) thalamotomy and Vim deep brain stimulation (DBS). We studied the lateralized effects of unilateral Vim thalamotomy and Vim DBS in ET patients.
Vim thalamotomy was performed in 6 patients and Vim DBS in 6. Patients were evaluated preoperatively and at 3 and 6 months postoperatively using the Clinical Rating Scale for Tremor (CRST).
The contralateral Part A (tremor localization/severity rating) and Part B (specific motor tasks/function rating) subscores, and axial subscores of CRST significantly improved after unilateral Vim thalamotomy or Vim DBS. On the side ipsilateral to surgery, ET patients demonstrated no significant improvements in the Part A and Part B subscores of CRST. The Part C (functional disabilities resulting from tremor) subscores and total scores of CRST were significantly improved after surgery.
Vim thalamotomy and DBS may be equally effective for the management of contralateral and axial tremor in ET patients, but both interventions may not improve tremor on the side ipsilateral to surgery.
立体定向丘脑切开术已成为治疗药物难治性原发性震颤（ET）的有效手术方法，但对于单侧腹侧中间核（Vim）丘脑切开术和 Vim 深部脑刺激（DBS）的双侧效应知之甚少。我们研究了单侧 Vim 丘脑切开术和 Vim DBS 在 ET 患者中的偏侧效应。
对 6 例患者进行 Vim 丘脑切开术，对 6 例患者进行 Vim DBS。患者在术前和术后 3 个月和 6 个月使用震颤临床评分量表（CRST）进行评估。
单侧 Vim 丘脑切开术或 Vim DBS 后，CRST 的对侧部分 A（震颤定位/严重程度评分）和部分 B（特定运动任务/功能评分）子评分以及轴向子评分均显著改善。在手术侧，ET 患者的 CRST 的部分 A 和部分 B 子评分无明显改善。CRST 的部分 C（震颤引起的功能障碍）子评分和总分在手术后显著改善。
Vim 丘脑切开术和 DBS 可能同样有效地治疗 ET 患者的对侧和轴向震颤，但这两种干预措施都可能无法改善手术侧的震颤。
