Hidding Ute, Lezius Susanne, Schaper Miriam, Buhmann Carsten, Gerloff Christian, Pötter-Nerger Monika, Hamel Wolfgang, Moll Christian K E, Choe Chi-Un
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Neuromodulation. 2023 Dec;26(8):1680-1688. doi: 10.1016/j.neurom.2022.09.009. Epub 2022 Nov 8.
Novel deep brain stimulation (DBS) systems allow directional and short-pulse stimulation to potentially improve symptoms and reduce side effects. The aim of this study was to investigate the effect of short-pulse and directional stimulation, in addition to a combination of both, in the ventral intermediate thalamus (VIM)/posterior subthalamic area (PSA) on tremor and stimulation-induced side effects in patients with essential tremor.
We recruited 11 patients with essential tremor and VIM/PSA-DBS. Tremor severity (Fahn-Tolosa-Marin), ataxia (International Cooperative Ataxia Rating Scale), and paresthesia (visual analog scale) were assessed with conventional omnidirectional and directional stimulation with pulse width of 60 μs and 30 μs.
All stimulation conditions reduced tremor. The best directional stimulation with 60 μs reduced more tremor than did most other stimulation settings. The best directional stimulation, regardless of pulse width, effectively reduced stimulation-induced ataxia compared with the conventional stimulation (ring 60 μs) or worst directional stimulation with 60 μs. All new stimulation modes reduced occurrence of paresthesia, but only the best directional stimulation with 30 μs attenuated paresthesia compared with the conventional stimulation (ring 60 μs) or worst directional stimulation with 60 μs. The best directional stimulation with 30 μs reduced tremor, ataxia, and paresthesia compared with conventional stimulation in most patients. Correlation analyses indicated that more anterior stimulation sites are associated with stronger ataxia reduction with directional 30 μs than with conventional 60 μs stimulation.
Directional and short-pulse stimulation, and a combination of both, revealed beneficial effects on stimulation-induced adverse effects.
新型深部脑刺激（DBS）系统允许进行定向和短脉冲刺激，有可能改善症状并减少副作用。本研究的目的是探讨除了将两者结合之外，在腹中间丘脑（VIM）/丘脑底后区（PSA）进行短脉冲和定向刺激对特发性震颤患者震颤及刺激引起的副作用的影响。
我们招募了11例接受VIM/PSA-DBS治疗的特发性震颤患者。使用脉宽为60μs和30μs的传统全向和定向刺激评估震颤严重程度（法恩-托洛萨-马林量表）、共济失调（国际合作共济失调评定量表）和感觉异常（视觉模拟量表）。
所有刺激条件均能减轻震颤。脉宽为60μs的最佳定向刺激比大多数其他刺激设置能更有效地减轻震颤。无论脉宽如何，与传统刺激（60μs环）或脉宽为60μs的最差定向刺激相比，最佳定向刺激能有效减轻刺激引起的共济失调。所有新的刺激模式均减少了感觉异常的发生，但只有脉宽为30μs的最佳定向刺激与传统刺激（60μs环）或脉宽为60μs的最差定向刺激相比，减轻了感觉异常。在大多数患者中，脉宽为30μs的最佳定向刺激与传统刺激相比，减轻了震颤、共济失调和感觉异常。相关性分析表明，与传统60μs刺激相比，在定向30μs刺激时，更靠前的刺激部位与更强的共济失调减轻相关。
定向和短脉冲刺激以及两者的结合，对刺激引起的不良反应显示出有益效果。
