Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; CEDOC, Nova Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.
Neurology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
Parkinsonism Relat Disord. 2018 Feb;47:8-14. doi: 10.1016/j.parkreldis.2017.12.014. Epub 2017 Dec 13.
Deep brain stimulation (DBS) is an effective treatment for essential tremor or tremor in Parkinson's disease. The effectiveness of DBS in reducing tremors that develop after a structural lesion of the central nervous system (such as Holmes' tremor - HT) has only been addressed in case reports or series. We conducted a systematic review of all published original reports of DBS in central nervous system lesion-related tremor (excluding demyelinating disorders due to their non-static nature). Where available, we extracted data regarding each patient's demographic, tremor and surgical details. Improvement was calculated as a percentage of change in any objective tremor rating scale. We identified 35 publications reporting on 82 patients. The ventral intermedius nucleus(VIM) of the thalamus was the preferred target (63.6%) and 18.2% targeted globus pallidus pars interna(GPi). Median improvement was 77.5% and 71.4% for patients with post-stroke and post-traumatic tremor respectively. Seven subjects (13.5%) had less than 50% improvement. Therapeutic effectiveness was not associated with age, tremor duration, age of onset or follow-up time. A large range of stimulation parameters were used with median voltage, pulse width and frequency values higher for GPi (4.80 V, 105 us, 170 Hz) than for thalamic stimulation (3.0 V, 90 us, 140 Hz). DBS reports for Holmes' and lesional tremors treatment are scarce and highly heterogeneous limiting a proper summary analysis and comparisons. Even facing a probable report bias, a high number of subjects with good long-term tremor control were found. These results should promote the creation of tremor registries before clinical trials.
深部脑刺激（DBS）是治疗原发性震颤或帕金森病震颤的有效方法。DBS 对中枢神经系统（如 Holmes 震颤-HT）结构性损伤后发生的震颤的有效性仅在病例报告或系列研究中得到解决。我们对所有关于中枢神经系统损伤相关性震颤的 DBS 发表的原始报告进行了系统回顾（不包括脱髓鞘疾病，因为它们的性质是非静态的）。在有可用数据的情况下，我们提取了每个患者的人口统计学、震颤和手术细节的数据。改善程度按任何客观震颤评定量表的变化百分比计算。我们确定了 35 篇报告 82 例患者的文献。丘脑腹中间核（VIM）是首选目标（63.6%），18.2%的目标是苍白球内侧部（GPi）。中风后和创伤后震颤患者的中位数改善分别为 77.5%和 71.4%。7 名患者（13.5%）改善不到 50%。治疗效果与年龄、震颤持续时间、发病年龄或随访时间无关。使用了广泛的刺激参数，GPi 的中位电压、脉冲宽度和频率值分别为 4.80 V、105 us 和 170 Hz，高于丘脑刺激的 3.0 V、90 us 和 140 Hz。关于 Holmes 震颤和损伤性震颤治疗的 DBS 报告很少，且高度异质性，限制了适当的总结分析和比较。即使存在可能的报告偏倚，也发现了大量长期震颤控制良好的患者。这些结果应促进在临床试验前创建震颤登记处。
