Kashyap Samir, Ceponiene Rita, Savla Paras, Bernstein Jacob, Ghanchi Hammad, Ananda Ajay
Department of Neurosurgery, Riverside University Health System, Moreno Valley, California, United States.
Department of Neurology, Kaiser Permanente Sourthern California Physician Medical Group, Los Angeles, California, United States.
Surg Neurol Int. 2020 Dec 16;11:444. doi: 10.25259/SNI_723_2020. eCollection 2020.
Tardive tremor (TT) is an underrecognized manifestation of tardive syndrome (TS). In our experience, TT is a rather common manifestation of TS, especially in a setting of treatment with aripiprazole, and is a frequent cause of referrals for the evaluation of idiopathic Parkinson disease. There are reports of successful treatment of tardive orofacial dyskinesia and dystonia with deep brain stimulation (DBS) using globus pallidus interna (GPi) as the primary target, but the literature on subthalamic nucleus (STN) DBS for tardive dyskinesia (TD) is lacking. To the best of our knowledge, there are no reports on DBS treatment of TT.
A 75-year-old right-handed female with the medical history of generalized anxiety disorder and major depressive disorder had been treated with thioridazine and citalopram from 1980 till 2010. Around 2008, she developed orolingual dyskinesia. She was started on tetrabenazine in June 2011. She continued to have tremors and developed Parkinsonian gait, both of which worsened overtime. She underwent DBS placement in the left STN in January 2017 with near-complete resolution of her tremors. She underwent right STN implantation in September 2017 with similar improvement in symptoms.
While DBS-GPi is the preferred treatment in treating oral TD and dystonia, DBS-STN could be considered a safe and effective target in patients with predominating TT and/or tardive Parkinsonism. This patient saw a marked improvement in her symptoms after implantation of DBS electrodes, without significant relapse or recurrence in the years following implantation.
迟发性震颤（TT）是迟发性综合征（TS）一种未得到充分认识的表现形式。根据我们的经验，TT是TS相当常见的一种表现，尤其是在使用阿立哌唑治疗的情况下，并且是转诊评估特发性帕金森病的常见原因。有报道称，以苍白球内侧部（GPi）为主要靶点，通过脑深部电刺激（DBS）成功治疗了迟发性口面部运动障碍和肌张力障碍，但关于丘脑底核（STN）DBS治疗迟发性运动障碍（TD）的文献较少。据我们所知，尚无关于DBS治疗TT的报道。
一名75岁右利手女性，有广泛性焦虑障碍和重度抑郁症病史，198从0年至2010年接受过硫利达嗪和西酞普兰治疗。2008年左右，她出现口面部运动障碍。2011年6月开始服用丁苯那嗪。她持续存在震颤，并出现帕金森步态，两者均随时间推移而加重。2017年1月，她在左侧STN植入DBS，震颤几乎完全缓解。2017年9月，她接受了右侧STN植入，症状有类似改善。
虽然DBS - GPi是治疗口部TD和肌张力障碍的首选方法，但对于以TT和/或迟发性帕金森症为主的患者，DBS - STN可被视为一个安全有效的靶点。该患者在植入DBS电极后症状有显著改善，植入后的几年内无明显复发或再发情况。
