Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA; Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA; Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Clin Neurophysiol. 2018 Aug;129(8):1628-1633. doi: 10.1016/j.clinph.2018.05.012. Epub 2018 Jun 5.
To identify pre-operative clinical and computerized spiral analysis characteristics that may help ascertain which patients with Essential Tremor (ET) will exhibit 'early tolerance' to ventral intermediate nucleus of thalamus (Vim) deep brain stimulation (DBS).
Identification of comparative characteristics of defined cases of 'early tolerance' versus patients with sustained satisfactory response treated with Vim DBS surgery for medically-refractory ET, based on retrospective chart review by a clinician blinded to the findings of computerized spiral analysis.
Statistically significant differences in two spiral analysis indices, SWVI and DoS, were found in the dominant upper limbs of patients who developed 'early tolerance', whereas the clinical characteristics were not significantly different.
Objective measurements of upper limb kinematics using graphonomic tests like spiral analysis should be considered in the pre-operative evaluation for DBS, especially in the setting of moderate-severe predominantly action and proximal postural tremors.
Ours is the first investigation looking into the pre-operative clinical and objective physiologic characteristics of the patients who develop 'early tolerance' to Vim DBS for the treatment of essential tremor. The study has significant implications for pre-operative evaluation and potential surgical target selection for the treatment of tremors.
确定术前临床和计算机螺旋分析特征，以帮助确定哪些特发性震颤（ET）患者将表现出丘脑腹中间核（Vim）深部脑刺激（DBS）的“早期耐受”。
通过对接受 Vim DBS 手术治疗药物难治性 ET 的患者进行回顾性图表审查，由对计算机螺旋分析结果不知情的临床医生对“早期耐受”患者与持续满意反应患者的特征进行比较。
在出现“早期耐受”的患者优势上肢中，发现了两个螺旋分析指标（SWVI 和 DoS）的统计学显著差异，而临床特征则没有显著差异。
使用图论测试（如螺旋分析）对上肢运动学进行客观测量，应在 DBS 的术前评估中考虑，尤其是在中度至重度主要为动作性和近端姿势性震颤的情况下。
我们的研究首次探讨了接受 Vim DBS 治疗特发性震颤的患者出现“早期耐受”的术前临床和客观生理特征。该研究对术前评估和震颤治疗的潜在手术靶点选择具有重要意义。
