用于特发性震颤的分段式与非分段式深部脑刺激在共济失调副作用方面存在差异。
Segmented versus Nonsegmented Deep-Brain Stimulation for Essential Tremor Differ in Ataxic Side Effects.
作者信息
Roque Daniel A
机构信息
University of North Carolina at Chapel Hill, North Carolina, US.
出版信息
Tremor Other Hyperkinet Mov (N Y). 2019 Mar 29;9:621. doi: 10.7916/d8-8vww-td18. eCollection 2019.
BACKGROUND
Directional, deep-brain stimulation may prove beneficial for targets (1) thinner along the lead trajectory, and (2) whose borders are not easily visible by neuroimaging. When targeting the ventral intermediate (VIM) nucleus of the thalamus for essential tremor, even baseline ataxia may be exacerbated by medial spread of current and antidromic stimulation of vestibular-cerebellar-thalamic afferents.
CASE REPORT
The present patient with essential tremor developed refractory head tremor leading to implantation of bilateral St. Jude/Abbott segmented leads into the VIM to afford additional programming options.
DISCUSSION
Video evidence showed that directional stimulation did not exacerbate ataxia beyond baseline, whereas nondirectional stimulation exacerbated ataxia consistently. We discuss how this programming advantage may help address a common complication from DBS implantation for essential tremor patients.
背景
定向性脑深部刺激可能对以下靶点有益：（1）沿电极轨迹更窄的靶点，以及（2）其边界通过神经影像学不易观察到的靶点。在针对丘脑腹中间核（VIM）治疗特发性震颤时，电流向内侧扩散以及前庭 - 小脑 - 丘脑传入纤维的逆向刺激甚至可能会加重基线时的共济失调。
病例报告
本特发性震颤患者出现难治性头部震颤，导致双侧圣犹达/雅培分段电极植入VIM，以提供更多的程控选项。
讨论
视频证据显示，定向刺激并未使共济失调加重超过基线水平，而非定向刺激则持续加重共济失调。我们讨论了这种程控优势如何有助于解决特发性震颤患者深部脑刺激植入的常见并发症。
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