Kundu Bornali, Schrock Lauren, Davis Tyler, House Paul A
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
Neuromodulation. 2018 Dec;21(8):748-754. doi: 10.1111/ner.12739. Epub 2017 Dec 12.
Voice tremor is a common feature of essential tremor (ET) that is difficult to treat medically and significantly affects quality of life. Deep brain stimulation (DBS) of the ventral intermediate nucleus (Vim) of the thalamus is effective in improving contralateral distal limb tremor and has been shown in limited studies to affect voice tremor. Our objective was to retrospectively evaluate whether Vim-DBS used to treat patients with essential motor tremor also effectively treated underlying concurrent voice tremor and assess whether particular lead locations were favorable for treating vocal tremor.
In this retrospective cohort study, patients had unilateral or bilateral lead placement and were monitored for up to 12 months. We used the Fahn-Tolosa-Marin (FTM) subscore to assess vocal tremor. Changes in vocal tremor before and after stimulation and over several sessions were assessed.
Of the 77 patients who met the inclusion criteria and were treated for essential tremor, 20 (26%) patients had vocal tremor prior to stimulation. Active Vim-DBS decreased the amplitude of voice tremor by 80% (p < 0.001). The mean FTM score as 1.24 pre-operation, 1.08 post-implantation (consistent with a lesion effect), and 0.25 with stimulation. The effect magnitude was maintained at last follow-up with slight improvement over time (p < 0.05). Unilateral and bilateral stimulation resulted in similar degrees of tremor reduction. A model of the centroid of stimulation showed that Vim thalamic stimulation that is more anterior on average yielded better voice tremor control, significantly so on the left side (p < 0.05). Additionally, there was improvement in head, tongue, and face tremor scores (p < 0.05).
Unilateral and bilateral Vim-DBS targeted to treat the motor component of essential tremor also dramatically decreased the amplitude of voice tremor in this group of patients, suggesting a potential benefit of this treatment for affected patients.
语音震颤是特发性震颤（ET）的常见特征，药物治疗困难且严重影响生活质量。丘脑腹中间核（Vim）的深部脑刺激（DBS）对改善对侧肢体远端震颤有效，且在有限的研究中显示对语音震颤有影响。我们的目的是回顾性评估用于治疗特发性运动性震颤患者的Vim-DBS是否也能有效治疗潜在的并发语音震颤，并评估特定的电极位置是否有利于治疗语音震颤。
在这项回顾性队列研究中，患者接受单侧或双侧电极植入，并进行长达12个月的监测。我们使用Fahn-Tolosa-Marin（FTM）子评分来评估语音震颤。评估刺激前后及多个疗程中语音震颤的变化。
在符合纳入标准并接受特发性震颤治疗的77例患者中，20例（26%）在刺激前存在语音震颤。有效的Vim-DBS使语音震颤幅度降低了80%（p < 0.001）。术前FTM平均评分为1.24，植入后为1.08（与损伤效应一致），刺激时为0.25。在最后一次随访时，效应大小得以维持，且随时间略有改善（p < 0.05）。单侧和双侧刺激导致的震颤减轻程度相似。刺激质心模型显示，平均而言，丘脑Vim刺激位置更靠前时，语音震颤控制效果更好，左侧尤为显著（p < 0.05）。此外，头部、舌头和面部震颤评分也有所改善（p < 0.05）。
针对特发性震颤运动成分的单侧和双侧Vim-DBS也显著降低了该组患者的语音震颤幅度，提示该治疗方法对受影响患者可能有益。
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