Tsuboi Takashi, Au Ka Loong Kelvin, Deeb Wissam, Almeida Leonardo, Foote Kelly D, Okun Michael S, Ramirez-Zamora Adolfo
Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
Parkinsonism Relat Disord. 2020 Jul;76:32-41. doi: 10.1016/j.parkreldis.2020.06.008. Epub 2020 Jun 8.
Dystonic tremor (DT) is defined as the tremor in body parts affected by dystonia. Although deep brain stimulation (DBS) has been used to manage medically-refractory DT patients, its efficacy has not been well established. The objective of this study is to provide an up-to-date systematic review of DBS outcomes for DT patients. We conducted a literature search using Medline, Embase, and Cochrane Library databases in February 2020 according to the PRISMA guidelines. From 858 publications, we identified 30 articles involving 89 DT patients who received DBS of different targets. Thalamic DBS was the most common (n = 39) and improved tremor by 40-50% potentially in the long-term over five years with variable effects on dystonic symptoms. Globus pallidus internus (GPi), subthalamic, and subthalamic nucleus (STN) DBS improved both tremor and dystonic symptoms; however, data were limited. A few studies have reported better tremor and dystonia outcomes with combinations of different targets. Concerning adverse effects, gait/balance disorders, and ataxia seemed to be more common among patients treated with thalamic or subthalamic DBS, whereas parkinsonian adverse effects were observed only in patients treated with subthalamic or GPi DBS. Comparative benefits and limitations of these targets remain unclear because of the lack of randomized controlled trials. In conclusion, DBS of these targets may improve tremor with a variable effect on dystonia with different adverse effect profiles. The shortcomings in the literature include long-term motor outcomes, quality of life outcomes, optimal DBS targeting, and DBS programming strategy.
肌张力障碍性震颤（DT）被定义为受肌张力障碍影响的身体部位出现的震颤。尽管深部脑刺激（DBS）已被用于治疗药物难治性DT患者，但其疗效尚未得到充分证实。本研究的目的是对DT患者的DBS治疗结果进行最新的系统评价。我们根据PRISMA指南于2020年2月使用Medline、Embase和Cochrane图书馆数据库进行了文献检索。从858篇出版物中，我们确定了30篇文章，涉及89例接受不同靶点DBS治疗的DT患者。丘脑DBS最为常见（n = 39），从长期来看，五年内可能使震颤改善40 - 50%，对肌张力障碍症状的影响各不相同。苍白球内侧部（GPi）、丘脑底核和丘脑底核（STN）DBS可同时改善震颤和肌张力障碍症状；然而，数据有限。一些研究报告了不同靶点联合使用时震颤和肌张力障碍的更好治疗效果。关于不良反应，步态/平衡障碍和共济失调在接受丘脑或丘脑底核DBS治疗的患者中似乎更为常见，而帕金森样不良反应仅在接受丘脑底核或GPi DBS治疗的患者中观察到。由于缺乏随机对照试验，这些靶点的相对益处和局限性仍不清楚。总之，这些靶点的DBS可能改善震颤，对肌张力障碍有不同影响，且不良反应谱不同。文献中的不足包括长期运动结果、生活质量结果、最佳DBS靶点和DBS程控策略。
