Shah Neha, Leventhal Daniel, Persad Carol, Patil Parag G, Chou Kelvin L
Michigan State University Medical School, East Lansing, MI, United States.
Surgical Therapies Improving Movement Program, University of Michigan, Ann Arbor, MI, United States; Department of Neurology, University of Michigan, Ann Arbor, MI, United States.
J Neurol Sci. 2016 Mar 15;362:165-8. doi: 10.1016/j.jns.2016.01.041. Epub 2016 Jan 21.
A comprehensive, multidisciplinary screening process for deep brain stimulation (DBS) candidates is recommended, but is often time-consuming.
To determine the number of essential tremor (ET) referrals excluded from surgery and why, in order to develop recommendations for a minimum standard DBS evaluation process.
We reviewed the referrals of 100 consecutive potential DBS candidates with presumed ET at our center, identified reasons for excluding patients from DBS, and the point at which they dropped out of our evaluation process.
Of the 100 tremor patients referred for DBS, 36 patients were approved for surgery. Patients were mainly excluded because of the movement disorders neurologist and neuropsychologist evaluations. Reasons included an inadequate medication trial (n=20), incorrect diagnosis (n=3), dementia (n=3), and antagonistic interactions with the team (n=1). 37 patients did not present, were uninterested or lost to follow-up. Neither neurosurgical evaluation nor brain imaging excluded candidates in this study, but are needed to proceed with DBS.
Our suggested minimum standard DBS screening process begins with a movement disorders neurologist and neuropsychologist evaluation in order to determine eligibility. Neurosurgical evaluation and brain imaging can then be performed if candidates are deemed eligible.
推荐对脑深部电刺激（DBS）候选者进行全面、多学科的筛查过程，但这通常很耗时。
确定被排除在手术之外的特发性震颤（ET）转诊患者数量及其原因，以便制定关于最低标准DBS评估过程的建议。
我们回顾了本中心连续100例疑似ET的潜在DBS候选者的转诊情况，确定将患者排除在DBS之外的原因，以及他们退出我们评估过程的时间点。
在转诊进行DBS的100例震颤患者中，36例患者被批准进行手术。患者主要因运动障碍神经科医生和神经心理学家的评估而被排除。原因包括药物试验不充分（n = 20）、诊断错误（n = 3）、痴呆（n = 3）以及与团队的对抗性互动（n = 1）。37例患者未就诊、不感兴趣或失访。在本研究中，神经外科评估和脑成像均未排除候选者，但进行DBS需要这些检查。
我们建议的最低标准DBS筛查过程首先由运动障碍神经科医生和神经心理学家进行评估以确定是否符合条件。如果候选者被认为符合条件，然后可进行神经外科评估和脑成像检查。
