Department of Clinical Neuroscience, Neurosurgery, Karolinska Institutet, Solna, Sweden.
Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
Stereotact Funct Neurosurg. 2022;100(4):248-252. doi: 10.1159/000525325. Epub 2022 Jun 27.
Essential tremor (ET) is the most common adult movement disorder. For the relatively large group of patients who do not respond adequately to pharmacological therapy, deep brain stimulation (DBS) is a well-established treatment option. Most ET patients will have bilateral symptoms, and many of them receive bilateral DBS. Unilateral DBS is however still the most common procedure, and some papers suggest an ipsilateral effect in these patients.
The aim of this study was to analyze if there is an ipsilateral effect of DBS for ET.
We retrospectively analyzed our patient cohort with DBS surgery from 1996 to 2017, selecting patients with ET that underwent surgery with unilateral DBS without previous DBS or lesional surgery. A total number of 68 patients (39 males, 29 females) were identified. The patients were evaluated twice: first, at a mean time of 12 months after surgery defined as short-term follow-up and then again at a mean time of 49 months after surgery defined as long-term follow-up, using the clinical rating scale for tremor (CRST).
The total CRST score was reduced from mean 49.5 points at baseline before surgery to 20.2 (p < 0.001) at short-term and 28.3 (p < 0.001) at long-term follow-up. Contralateral tremor was reduced from mean 6.1 to 0.4 (p < 0.001) and 1.2 (p < 0.001), respectively. Contralateral hand function was reduced from 11.5 to 2.6 (p < 0.001) and 4.6 (p < 0.001), respectively. Ipsilateral hand function scored 9 at baseline, 8.3 at 1 year, and then again 9.4 at long-term follow-up. Ipsilateral tremor scored 4.0 at baseline, 3.7 at 1 year, and 4.3 at long-term follow-up. Neither ipsilateral hand function nor ipsilateral tremor showed significant difference.
There was no difference in severity of ipsilateral tremor, neither at 1 year nor in the long term. We believe ipsilateral effects of DBS for ET merits limited consideration regarding decision-making or patient counseling before surgery.
特发性震颤（ET）是最常见的成人运动障碍。对于那些对药物治疗反应不佳的较大患者群体，深部脑刺激（DBS）是一种成熟的治疗选择。大多数 ET 患者会有双侧症状，其中许多患者接受双侧 DBS。然而，单侧 DBS 仍然是最常见的手术，一些论文表明这些患者存在同侧效应。
本研究旨在分析 DBS 治疗 ET 是否存在同侧效应。
我们回顾性分析了 1996 年至 2017 年接受 DBS 手术的患者队列，选择接受单侧 DBS 手术且无既往 DBS 或病灶手术的 ET 患者。共确定了 68 名患者（39 名男性，29 名女性）。患者在两次评估中接受了评估：首先，在手术后平均 12 个月时进行评估，定义为短期随访，然后在手术后平均 49 个月时再次评估，定义为长期随访，使用震颤临床评分量表（CRST）。
总 CRST 评分从术前基线的平均 49.5 分降至术后短期随访的 20.2 分（p<0.001）和长期随访的 28.3 分（p<0.001）。对侧震颤从平均 6.1 分降至 0.4 分（p<0.001）和 1.2 分（p<0.001）。对侧手部功能从 11.5 分降至 2.6 分（p<0.001）和 4.6 分（p<0.001）。同侧手部功能在基线时评分为 9 分，在 1 年时评分为 8.3 分，然后在长期随访时再次评分为 9.4 分。同侧震颤在基线时评分为 4.0 分，在 1 年时评分为 3.7 分，在长期随访时评分为 4.3 分。同侧手部功能和同侧震颤均无显著差异。
在 1 年和长期随访中，同侧震颤的严重程度均无差异。我们认为 ET 的 DBS 同侧效应在手术前的决策或患者咨询中值得有限考虑。
