Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan,
Stereotact Funct Neurosurg. 2021;99(2):107-112. doi: 10.1159/000510593. Epub 2021 Jan 5.
Head tremor in patients with dystonia is referred to as dystonic tremor. During surgical treatment, numerous targets may be selected, including the internal segment of the globus pallidus and the ventral intermediate (Vim) nucleus; however, there is no consensus concerning the most effective treatment target. We report herein a case of dystonic head tremor in which improvement persisted for 5 years after deep brain stimulation (DBS) of the bilateral thalamic Vim and ventro-oral internus (Voi) nuclei. The patient, a 67-year-old woman, has a horizontal head tremor associated with cervical dystonia that had been resistant to drug treatment over 3 years. Immediately following surgery, dystonia and tremor symptoms had completely improved. Voice volume declined and dysarthria occurred but improved upon adjusting the stimulation conditions. Over 5 years, both head tremor and cervical dystonia have been completely controlled, and no other obvious complications have been observed. As the Voi nucleus receives pallidothalamic projections involved in dystonia and the Vim nucleus receives cerebellothalamic projections involved in tremors, stimulating these 2 nuclei with the same electrode appears reasonable in the treatment of dystonic tremor. This case suggests that Vim-Voi DBS may be effective for treating dystonic head tremor.
头部震颤在肌张力障碍患者中被称为肌张力障碍性震颤。在手术治疗中，可能会选择多个目标，包括苍白球内节和腹侧中间核（Vim）；然而，对于最有效的治疗目标尚无共识。我们在此报告一例双侧丘脑 Vim 和腹侧口内（Voi）核深部脑刺激（DBS）治疗后持续 5 年的肌张力障碍性头部震颤病例。患者为 67 岁女性，存在与颈肌张力障碍相关的水平性头部震颤，且对 3 年以上的药物治疗无效。手术后立即，肌张力障碍和震颤症状完全改善。术后声音音量下降，出现构音障碍，但通过调整刺激条件后得到改善。5 年来，头部震颤和颈肌张力障碍均得到完全控制，且未观察到其他明显并发症。由于 Voi 核接收与肌张力障碍有关的苍白球丘脑投射，而 Vim 核接收与震颤有关的小脑丘脑投射，因此用同一电极刺激这 2 个核似乎是合理的，可用于治疗肌张力障碍性震颤。该病例提示 Vim-Voi DBS 可能对治疗肌张力障碍性头部震颤有效。
