Isobe Takashi, Sato Hiromasa, Goto Tetsuya, Yako Takehiro, Yoshida Kunihiro, Hashimoto Takao
Department of Neurology, Aizawa Hospital, Matsumoto, Japan.
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Stereotact Funct Neurosurg. 2019;97(4):241-243. doi: 10.1159/000504062. Epub 2019 Nov 19.
The beneficial effect of thalamic deep brain stimulation (DBS) on action tremor has been reported in a few cases of spinocerebellar ataxia (SCA); however, several factors should be taken into account regarding the indication for DBS in advanced cases. We performed DBS of the ventral intermediate nucleus (Vim) of the thalamus for treatment of coarse action tremor in a patient with SCA2 (spinocerebellar ataxia type 2) in the wheelchair-bound stage. Although improvement of the tremor of the proximal part was incomplete, the patient regained substantial parts of daily functioning. The effect lasted for more than 6 years, and the suppression of tremor significantly contributed to maintaining the level of the patient's expression into the bedridden stage. Vim DBS can be a treatment option for tremor in SCA patients, even in the advanced stage, as long as the tremor is depriving the patient of behavioral expression. As residual proximal tremor may hamper functional recovery, DBS of other targets or multi-targets should be further explored to attain a better outcome.
丘脑深部脑刺激（DBS）对少数脊髓小脑共济失调（SCA）患者的动作性震颤具有有益效果；然而，对于晚期病例中DBS的适应症，应考虑几个因素。我们对一名处于轮椅依赖阶段的SCA2（2型脊髓小脑共济失调）患者进行了丘脑腹中间核（Vim）的DBS治疗，以治疗其粗大动作性震颤。尽管近端震颤的改善并不完全，但患者恢复了大部分日常功能。这种效果持续了6年多，震颤的抑制显著有助于患者维持其活动能力至卧床阶段。Vim DBS可以作为SCA患者震颤的一种治疗选择，即使在晚期，只要震颤影响患者的行为表现。由于残留的近端震颤可能妨碍功能恢复，应进一步探索其他靶点或多靶点的DBS以获得更好的效果。
