Bagatti Davide, D'Ammando Antonio, Franzini Angelo, Messina Giuseppe
University of Milan, Faculty of Medicine, Milan, Italy.
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
World Neurosurg. 2019 May;125:191-197. doi: 10.1016/j.wneu.2019.01.183. Epub 2019 Feb 8.
Dystonic tremor is defined as a tremor occurring in a body region affected by dystonia. The pathophysiologic mechanisms behind dystonic tremor supposedly involve anomalies affecting the pallidothalamic-receiving area (for the dystonic component) and the ventralis intermedius-cortical loop (for the tremor component). Interest in posterior subthalamic area stimulation for various types of involuntary abnormal movements has arisen owing to positive results in patients affected by tremor refractory to ventralis intermedius deep brain stimulation.
A 23-year-old man, with a 15-year history of left upper limb dystonic tremor due to a stroke in the right thalamus, underwent deep brain stimulation with a single electrode passing through the right ventralis oralis anterior/ventralis oralis posterior nuclei and caudal zona incerta. Objective movement outcomes were assessed through the Unified Dystonia Rating Scale and Fahn-Tolosa-Marin Clinical Rating Scale for Tremor. The impact of tremor on activities of daily living was assessed with the ADL-T24 questionnaire, and quality of life was assessed with the Quality of Life Scale. All questionnaires were administered before deep brain stimulation and at 5-year follow-up. Unified Dystonia Rating Scale and Fahn-Tolosa-Marin Clinical Rating Scale for Tremor scores decreased from 14.5 to 4.5 and from 46 to 7, respectively. ADL-T24 score decreased from 19 to 3, whereas Quality of Life Scale score increased from 49 to 82.
Stimulation of motor thalamus and caudal zona incerta could be a viable treatment for patients affected by tremor of various origins, including dystonic tremor, refractory to medical therapy.
肌张力障碍性震颤被定义为在受肌张力障碍影响的身体部位出现的震颤。肌张力障碍性震颤背后的病理生理机制据推测涉及影响苍白球丘脑接收区（针对肌张力障碍成分）和腹中间核 - 皮质环路（针对震颤成分）的异常。由于对腹中间核深部脑刺激难治的震颤患者取得了积极结果，人们对丘脑底后区刺激治疗各种类型的不自主异常运动产生了兴趣。
一名23岁男性，因右侧丘脑中风导致左上肢肌张力障碍性震颤15年，接受了深部脑刺激，单个电极穿过右侧腹前核/腹后核和尾侧未定带。通过统一肌张力障碍评定量表和法恩 - 托洛萨 - 马林震颤临床评定量表评估客观运动结果。用ADL - T24问卷评估震颤对日常生活活动的影响，用生活质量量表评估生活质量。所有问卷在深部脑刺激前和5年随访时进行。统一肌张力障碍评定量表和法恩 - 托洛萨 - 马林震颤临床评定量表评分分别从14.5降至4.5和从46降至7。ADL - T24评分从19降至3，而生活质量量表评分从49升至82。
刺激运动丘脑和尾侧未定带可能是对包括肌张力障碍性震颤在内的各种起源的、药物治疗难治的震颤患者的一种可行治疗方法。
