Huss Diane S, Dallapiazza Robert F, Shah Binit B, Harrison Madaline B, Diamond Joshua, Elias W Jeff
Department of Physical Therapy, University of Virginia HealthSystem, Charlottesville, Virginia, USA.
Department of Neurosurgery, University of Virginia HealthSystem, Charlottesville, Virginia, USA.
Mov Disord. 2015 Dec;30(14):1937-43. doi: 10.1002/mds.26455. Epub 2015 Nov 17.
Thalamic deep brain stimulation (DBS) has largely replaced radiofrequency thalamotomy as the treatment of choice for disabling, medication-refractory essential tremor. Recently, the development of transcranial, high-intensity focused ultrasound has renewed interest in thalamic lesioning. The purpose of this study is to compare functional outcomes and quality of life in essential tremor patients treated with either bilateral Vim DBS or unilateral procedures (focused ultrasound or DBS). We hypothesized that all three would effectively treat the dominant hand and positively impact functional outcomes and quality of life as measured with the Clinical Rating Scale for Tremor and the Quality of Life in Essential Tremor Questionnaire.
This is a retrospective study of medication-refractory essential tremor patients treated at the University of Virginia with bilateral Vim DBS (n = 57), unilateral Vim DBS (n = 13), or unilateral focused ultrasound Vim thalamotomy (n = 15). Tremor was rated for all patients before and after treatment, using the Clinical Rating Scale for Tremor and Quality of Life in Essential Tremor Questionnaire.
Patients undergoing bilateral DBS treatment had more baseline tremor and worse quality of life scores. Patients had significant improvements in tremor symptoms and quality of life with all three treatments. Both DBS procedures improved axial tremor. No difference was seen in the degree of improvement in upper extremity tremor score, disability, or overall quality of life between bilateral and either unilateral procedure.
Bilateral thalamic DBS improves overall tremor more than unilateral DBS or focused ultrasound treatment; however, unilateral treatments are equally effective in treating contralateral hand tremor. Despite the greater overall tremor reduction with bilateral DBS, there is no difference in disability or quality of life comparing bilateral versus unilateral treatments.
丘脑深部脑刺激术（DBS）已在很大程度上取代了射频丘脑切开术，成为治疗难治性致残性特发性震颤的首选方法。最近，经颅高强度聚焦超声的发展重新引发了人们对丘脑毁损术的兴趣。本研究的目的是比较接受双侧腹中间核DBS或单侧手术（聚焦超声或DBS）治疗的特发性震颤患者的功能结局和生活质量。我们假设这三种治疗方法都能有效治疗优势手，并对震颤临床评分量表和特发性震颤生活质量问卷所衡量的功能结局和生活质量产生积极影响。
这是一项对在弗吉尼亚大学接受治疗的难治性特发性震颤患者的回顾性研究，这些患者接受了双侧腹中间核DBS（n = 57）、单侧腹中间核DBS（n = 13）或单侧聚焦超声腹中间核丘脑切开术（n = 15）。使用震颤临床评分量表和特发性震颤生活质量问卷对所有患者治疗前后的震颤进行评分。
接受双侧DBS治疗的患者基线震颤更多，生活质量评分更差。所有三种治疗方法均使患者的震颤症状和生活质量有显著改善。两种DBS手术均改善了轴性震颤。双侧手术与任何一种单侧手术在上肢震颤评分、残疾程度或总体生活质量的改善程度上均无差异。
双侧丘脑DBS比单侧DBS或聚焦超声治疗能更有效地改善整体震颤；然而，单侧治疗在治疗对侧手部震颤方面同样有效。尽管双侧DBS能更大程度地减轻整体震颤，但在残疾程度或生活质量方面，双侧治疗与单侧治疗并无差异。
