Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, University of Florida, Gainesville, FL, USA.
Department of Neurology, BayCare Medical Group, Tampa, FL, USA.
Parkinsonism Relat Disord. 2020 Nov;80:47-53. doi: 10.1016/j.parkreldis.2020.09.009. Epub 2020 Sep 10.
Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) thalamus is highly effective to treat medication-refractory essential tremor (ET). Complications of stimulation-induced ataxia and tolerance have been reported in limited series, ranging from 5 to 40%.
We analyzed a large single-center cohort of ET patients treated with thalamic DBS to assess rates of ataxia and tolerance.
Retrospective study of all ET patients that underwent VIM DBS at Mayo Clinic from 2010 to 2014. Demographic, clinical and DBS data were extracted. Risk factors, complications and time to onset of tolerance and ataxia were examined.
One hundred and thirteen ET patients (51% male) of mean age 68 ± 10 years and mean ET duration 27 ± 18 years underwent DBS during the study period. Of these, 98 (87%) had follow-up of ≥6 months (mean 4.0 ± 1.5 years) and were included for analysis. Complications of isolated ataxia (26%), isolated tolerance (4%), both tolerance and ataxia (9%), or neither (61%) were identified. Development of ataxia was about 3 times more common than tolerance (35% vs. 13%). The mean time to ataxia was 5.5 ± 0.3 years postoperatively. Risk factors for ataxia were baseline ataxic features, older age, and shorter ET disease duration. Small sample size limited calculation of risk factors and onset time for tolerance.
Stimulation-related ataxia occurred in one-third of ET patients, while tolerance was less common. Presence of baseline ataxia, age, and disease duration may aid counseling of stimulation-related ataxia risk. Larger studies are warranted to confirm these findings and further assess risk factors for tolerance.
深部脑刺激（DBS）对腹侧中间核（VIM）丘脑治疗药物难治性特发性震颤（ET）非常有效。刺激诱导的共济失调和耐受性的并发症在有限的系列中已被报道，范围从 5 到 40%。
我们分析了一个大型的单中心 ET 患者队列，这些患者接受了丘脑 DBS 治疗，以评估共济失调和耐受性的发生率。
对 2010 年至 2014 年在 Mayo 诊所接受 VIM-DBS 的所有 ET 患者进行回顾性研究。提取人口统计学、临床和 DBS 数据。检查了风险因素、并发症以及出现耐受性和共济失调的时间。
在研究期间，113 名 ET 患者（51%为男性）平均年龄 68±10 岁，ET 平均持续时间 27±18 年，接受了 DBS。其中，98 例（87%）的随访时间≥6 个月（平均 4.0±1.5 年），并纳入分析。发现了孤立性共济失调（26%）、孤立性耐受性（4%）、耐受性和共济失调（9%）或两者都没有（61%）的并发症。共济失调的发生率约为耐受性的 3 倍（35%比 13%）。共济失调的平均时间是术后 5.5±0.3 年。共济失调的危险因素是基线共济失调特征、年龄较大和 ET 疾病持续时间较短。由于样本量小，限制了对耐受性的危险因素和发病时间的计算。
在 ET 患者中，有三分之一发生了与刺激相关的共济失调，而耐受性则较少见。基线共济失调、年龄和疾病持续时间的存在可能有助于预测刺激相关的共济失调风险。需要更大的研究来证实这些发现，并进一步评估耐受性的危险因素。
