Patel Amar, Deeb Wissam, Okun Michael S
Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.
Fixel Center for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, USA.
Tremor Other Hyperkinet Mov (N Y). 2018 Jun 20;8:557. doi: 10.7916/D8P85VBQ. eCollection 2018.
A 64-year-old female with essential tremor (ET) presents for evaluation of deep brain stimulation (DBS) candidacy. Examination revealed subtle dystonic features as well as a disabling postural-action tremor.
Can dystonia occur in the setting of the diagnosis of ET and can its presence alter DBS target selection?
Unilateral DBS implantation of the ventralis intermedius (Vim) led to improvement in both tremor and dystonic posturing.
Case reports of DBS in dystonic tremor suggest Vim, globus pallidus internus (GPi), and subthalamic targets may all be effective, to varying degrees, in improving both tremor and dystonia. More rigorous studies are needed to identify the optimal target(s).
This case underscores the limited evidence available to guide a clinician's choice of DBS targets in patients with ET and dystonia. The severity of the dystonia and the presence of more generalized dystonia may alter the thinking about optimal targeting. Vim, GPi, and subthalamic targets appear potentially acceptable options, though Vim is usually the first target attempted when postural-action tremor is the chief complaint. Occasionally, a second rescue DBS lead may be necessary.
一名64岁患有特发性震颤（ET）的女性前来评估深部脑刺激（DBS）治疗的适用性。检查发现有轻微的肌张力障碍特征以及严重的姿势性动作震颤。
肌张力障碍会在ET诊断背景下出现吗？其出现会改变DBS靶点的选择吗？
腹中间核（Vim）单侧DBS植入术使震颤和肌张力障碍姿势均得到改善。
关于肌张力障碍性震颤DBS治疗的病例报告表明，Vim、苍白球内侧部（GPi）和丘脑底核靶点在不同程度上可能对改善震颤和肌张力障碍均有效。需要更严格的研究来确定最佳靶点。
该病例强调了指导临床医生选择ET和肌张力障碍患者DBS靶点的现有证据有限。肌张力障碍的严重程度以及更广泛的肌张力障碍的存在可能会改变对最佳靶点的考虑。Vim、GPi和丘脑底核靶点似乎是潜在可接受的选择，不过当姿势性动作震颤是主要症状时，Vim通常是首先尝试的靶点。偶尔，可能需要植入第二个挽救性DBS电极。
