Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Research Group Experimental ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
Parkinsonism Relat Disord. 2022 Nov;104:115-120. doi: 10.1016/j.parkreldis.2022.10.001. Epub 2022 Oct 6.
Orthostatic tremor is a rare and debilitating movement disorder. Its first-line treatment is pharmacological. For pharmaco-refractory patients, surgical treatment options such as deep brain stimulation (DBS) and spinal cord stimulation (SCS) have been investigated recently.
We conducted a systematic review of all published outcome and safety data on DBS and SCS for orthostatic tremor patients.
We searched Pubmed and Embase for studies describing orthostatic tremor patients treated with DBS or SCS. We collected all available outcome and safety data and our primary endpoint was the change in unsupported stance duration 1 year postoperatively (±6 months).
We included 15 studies, reporting on 32 orthostatic tremor patients who underwent DBS, 4 patients SCS and 2 both. The ventral intermediate nucleus and the zona incerta were targeted in 25/34 and 9/34 DBS cases, respectively. The median stance time at 1 year follow-up was 240 s compared to 30 s pre-operatively (p < 0.001). Stimulation-induced side effects occurred in the majority of patients, but were often transient. Bilateral stimulation appeared more effective than unilateral and stimulation settings were comparable to thalamic DBS for essential tremor. There were insufficient data available to draw meaningful conclusions on the long-term effects of DBS. Due to insufficient data, no conclusions could be drawn on the effects of SCS on orthostatic tremor.
DBS may be effective to increase stance time in orthostatic tremor patients in the first year, but further research is necessary to evaluate the long-term effects and the role of spinal cord stimulation.
直立性震颤是一种罕见且使人虚弱的运动障碍。其一线治疗是药物治疗。对于药物难治性患者，最近已经研究了手术治疗选择，如深部脑刺激（DBS）和脊髓刺激（SCS）。
我们对所有已发表的关于 DBS 和 SCS 治疗直立性震颤患者的结果和安全性数据进行了系统回顾。
我们在 Pubmed 和 Embase 上搜索描述接受 DBS 或 SCS 治疗的直立性震颤患者的研究。我们收集了所有可用的结果和安全性数据，我们的主要终点是术后 1 年（±6 个月）无支撑站立时间的变化。
我们纳入了 15 项研究，报告了 32 例接受 DBS 的直立性震颤患者、4 例 SCS 患者和 2 例同时接受 DBS 和 SCS 患者。25/34 例 DBS 病例和 9/34 例 DBS 病例的目标是腹侧中间核和未定带。1 年随访时的站立时间中位数为 240 秒，而术前为 30 秒（p<0.001）。大多数患者出现刺激诱导的副作用，但通常是短暂的。双侧刺激比单侧刺激更有效，刺激设置与丘脑 DBS 治疗原发性震颤相当。由于数据不足，无法对 DBS 的长期效果得出有意义的结论。由于数据不足，无法对 SCS 对直立性震颤的影响得出结论。
DBS 可能在直立性震颤患者的前 1 年内有效增加站立时间，但需要进一步研究来评估长期效果和脊髓刺激的作用。
