From the Department of Neurology (M.T.B., P.R., T.A.D., J.B., J.K.S., H.S.D., G.R.F., L.T.) and Department of Stereotaxy and Functional Neurosurgery (T.A.D., J.W., V.V.-V.), University Hospital of Cologne; Institute of Medical Statistics and Computational Biology (S.H., J.F.) and Clinical Trials Center Cologne (D.K.), University of Cologne; Neurological Rehabilitation Center Godeshöhe (N.A.), Bonn, Germany; National Parkinson Foundation International Centre of Excellence (H.S.D.), Kings College Hospital, London, UK; Department of Stereotactic Neurosurgery (J.V.), Otto-von-Guericke University Magdeburg and Leibniz Institute for Neurobiology; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; and Department of Neurology (L.T.), University Hospital Marburg, Germany
From the Department of Neurology (M.T.B., P.R., T.A.D., J.B., J.K.S., H.S.D., G.R.F., L.T.) and Department of Stereotaxy and Functional Neurosurgery (T.A.D., J.W., V.V.-V.), University Hospital of Cologne; Institute of Medical Statistics and Computational Biology (S.H., J.F.) and Clinical Trials Center Cologne (D.K.), University of Cologne; Neurological Rehabilitation Center Godeshöhe (N.A.), Bonn, Germany; National Parkinson Foundation International Centre of Excellence (H.S.D.), Kings College Hospital, London, UK; Department of Stereotactic Neurosurgery (J.V.), Otto-von-Guericke University Magdeburg and Leibniz Institute for Neurobiology; Cognitive Neuroscience (G.R.F.), Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; and Department of Neurology (L.T.), University Hospital Marburg, Germany.
Neurology. 2018 Aug 7;91(6):e543-e550. doi: 10.1212/WNL.0000000000005956. Epub 2018 Jul 3.
To evaluate deep brain stimulation (DBS) of the posterior subthalamic area (PSA) in essential tremor (ET) and compare it to the ventral intermediate nucleus of the thalamus (VIM) in terms of stimulation efficacy, efficiency, and side effects.
DBS leads were implanted such that contacts were placed in the VIM, on the intercommissural line, and in the PSA. Thirteen patients with ET entered a randomized, double-blind crossover phase and completed a 1-year follow-up.
PSA-DBS significantly reduced tremor severity and improved quality of life. There were no relevant differences in quality and frequency of stimulation side effects between VIM and PSA, with a tendency toward greater tremor improvement with PSA stimulation. Clinical benefit was achieved at significantly lower stimulation amplitudes in the PSA. The majority of patients remained with PSA-DBS after 1 year.
In accordance with previous retrospective investigations, our prospective data suggest that PSA-DBS is at least equally effective as but possibly more efficient than VIM-DBS.
This study provides Class I evidence that for patients with essential tremor, PSA-DBS is not significantly different from VIM-DBS in suppressing tremor, but clinical benefit from PSA-DBS is attained at lower stimulation amplitudes.
评估深部脑刺激（DBS）对原发性震颤（ET）的后丘脑下核（PSA）的疗效，并与丘脑腹侧中间核（VIM）在刺激效果、效率和副作用方面进行比较。
将 DBS 导联植入，使触点位于 VIM、连合间线和 PSA 中。13 例 ET 患者进入随机、双盲交叉阶段，并完成了 1 年的随访。
PSA-DBS 可显著降低震颤严重程度并改善生活质量。VIM 和 PSA 之间的刺激副作用的质量和频率没有明显差异，PSA 刺激有更大的震颤改善趋势。在 PSA 中，获得临床益处所需的刺激幅度明显较低。大多数患者在 1 年后仍保持 PSA-DBS。
与之前的回顾性研究一致，我们的前瞻性数据表明，PSA-DBS 在抑制震颤方面与 VIM-DBS 至少同样有效，但可能更有效。
本研究提供了 I 级证据，对于原发性震颤患者，PSA-DBS 在抑制震颤方面与 VIM-DBS 无显著差异，但 PSA-DBS 的临床获益在较低的刺激幅度下即可获得。
