Department of Neurology and Rehabilitation Medicine, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA.
Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
Cerebellum. 2023 Oct;22(5):1039-1044. doi: 10.1007/s12311-022-01477-2. Epub 2022 Sep 9.
Essential tremor (ET) may present with head tremor (HT), of presumed cerebellar nature. Deep brain stimulation (DBS) targeting the ventral intermediate (Vim) nucleus of the thalamus is a highly effective therapy for medication-refractory ET. However, stimulation-related side effects may include cerebellar abnormalities, such as postural instability. This retrospective cohort study evaluated the risk of post-Vim DBS postural instability (primary outcome measure) in patients with versus without head tremor (HT vs. nHT). The primary outcome measure, namely post-DBS postural instability, was assessed in both groups using a Wilcoxon rank sum t-test. The time to postural instability was determined using Cox proportional hazards regression analysis adjusted for age and sex. Out of 30 patients analyzed during the follow up period, there was similar postural instability detected in HT (9/14, 64%) and nHT patients (11/16, 69%) at 24 months post-Vim DBS (p=0.82), adjusted hazard ratio[aHR]=0.82, p=0.69). These data suggest that the presence or absence of HT does not have an impact on postural instability after bilateral Vim DBS in patients with ET.
特发性震颤（ET）可能表现为头部震颤（HT），推测与小脑有关。深部脑刺激（DBS）靶向丘脑腹中间核（Vim）是治疗药物难治性 ET 的有效方法。然而，刺激相关的副作用可能包括小脑异常，如姿势不稳。这项回顾性队列研究评估了 Vim 后 DBS 后姿势不稳（主要结局指标）在有头部震颤（HT）和无头部震颤（nHT）的患者中的风险。主要结局指标，即 DBS 后姿势不稳，在两组中均使用 Wilcoxon 秩和检验进行评估。使用 Cox 比例风险回归分析调整年龄和性别后，确定姿势不稳的时间。在随访期间分析的 30 例患者中，在 Vim 后 DBS 后 24 个月时，HT（9/14，64%）和 nHT 患者（11/16，69%）均检测到类似的姿势不稳（p=0.82），调整后的危险比[aHR]=0.82，p=0.69）。这些数据表明，ET 患者双侧 Vim DBS 后，HT 的存在与否对姿势不稳没有影响。
