Wang Tony R, Dallapiazza Robert F, Moosa Shayan, Huss Diane, Shah Binit B, Elias W Jeffrey
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Department of Physical Therapy, University of Virginia Health System, Charlottesville, Virginia, USA.
Stereotact Funct Neurosurg. 2018;96(1):60-64. doi: 10.1159/000486646. Epub 2018 Feb 12.
A recent randomized controlled trial investigating unilateral MRI-guided focused ultrasound (FUS) for essential tremor demonstrated efficacy. The long-term durability of this thalamotomy, however, is unknown. Furthermore, the feasibility of stimulating a previously lesioned target such as the thalamic nucleus ventralis intermedius (Vim) is poorly understood. We report a case of tremor recurrence, following an initially successful FUS thalamotomy, in which Vim-DBS was subsequently utilized to regain tremor control.
An 81-year-old right-handed female with medically refractory essential tremor (a Clinical Rating Scale for Tremor [CRST] value of 73) underwent left-sided FUS thalamotomy with initial abolition of right-upper extremity tremor. By the 6-month follow-up, there was complete recurrence of tremor (a CRST value of 76). The patient subsequently underwent left-sided Vim-DBS.
Vim-DBS provided clinical improvement with a CRST value of 42 at the 3-month follow-up; the patient continues to do clinically well at the 6-month follow-up. This result mirrors previous reported cases of stimulation following radiofrequency and gamma-knife lesioning. Our literature review highlights several reasons for the waning of clinical benefit seen with lesional procedures.
This case demonstrates that thalamic DBS can salvage a failed FUS thalamotomy and also the feasibility of stimulating a previously lesioned target.
最近一项关于单侧磁共振成像引导聚焦超声（FUS）治疗特发性震颤的随机对照试验证明了其有效性。然而，这种丘脑切开术的长期疗效尚不清楚。此外，刺激先前受损的靶点，如丘脑腹中间核（Vim）的可行性也知之甚少。我们报告了一例在最初成功的FUS丘脑切开术后震颤复发的病例，随后采用Vim深部脑刺激（DBS）重新控制震颤。
一名81岁右利手女性，患有药物难治性特发性震颤（震颤临床评分量表[CRST]值为73），接受了左侧FUS丘脑切开术，术后右上肢震颤最初消失。在6个月的随访中，震颤完全复发（CRST值为76）。该患者随后接受了左侧Vim-DBS。
Vim-DBS在3个月的随访中使临床症状改善，CRST值为42；在6个月的随访中，患者临床状况持续良好。这一结果与先前报道的射频和伽玛刀损伤后刺激的病例相符。我们的文献综述强调了导致损伤性手术临床益处减弱的几个原因。
该病例表明丘脑DBS可以挽救失败的FUS丘脑切开术，也证明了刺激先前受损靶点的可行性。
