与用于治疗原发性震颤的 DBS 中的阴极脉冲相比，对称双相脉冲的急性刺激可导致较少的共济失调。
Acute stimulation with symmetric biphasic pulses induces less ataxia compared to cathodic pulses in DBS for essential tremor.
机构信息
Exp ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Neurology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.
Exp ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
出版信息
Parkinsonism Relat Disord. 2023 Jun;111:105435. doi: 10.1016/j.parkreldis.2023.105435. Epub 2023 May 8.
BACKGROUND
Symmetric biphasic pulses have been shown to acutely increase the therapeutic window of ventralis intermedius deep brain stimulation (Vim-DBS) for essential tremor (ET) compared to cathodic pulses. Acute supratherapeutic stimulation can induce ataxic side effects in Vim-DBS.
OBJECTIVE
To investigate the effect on tremor, ataxia and dysarthria of 3 h of biphasic stimulation in patients with DBS for ET.
METHODS
A randomized, doubled-blind, cross-over design was used to compare standard cathodic pulses with symmetric biphasic pulses (anode-first) during a 3-h period per pulse shape. During each 3-h period, all stimulation parameters were identical, except for the pulse shape. Tremor (Fahn-Tolosa-Marin Tremor Rating Scale), ataxia (International Cooperative Ataxia Rating Scale) and speech (acoustic and perceptual measures) were assessed hourly during the 3-h periods.
RESULTS
Twelve ET patients were included. During the 3-h stimulation period, tremor control was equivalent between the two pulse shapes. Biphasic pulses elicited significantly less ataxia than cathodic pulses (p = 0.006). Diadochokinesis rate of speech was better for the biphasic pulse (p = 0.048), but other measures for dysarthria were not significantly different between the pulses.
CONCLUSION
Symmetric biphasic pulses induce less ataxia than conventional pulses after 3 h of stimulation DBS in ET patients.
背景
与阴极脉冲相比，对称双相脉冲已被证明可急性增加腹侧中间脑深部刺激（Vim-DBS）治疗特发性震颤（ET）的治疗窗口。急性超治疗刺激会在 Vim-DBS 中引起共济失调的副作用。
目的
研究双侧刺激 3 小时对接受 DBS 治疗 ET 患者震颤、共济失调和构音障碍的影响。
方法
采用随机、双盲、交叉设计，比较了每脉冲形状 3 小时期间的标准阴极脉冲与对称双相脉冲（阳极先）。在每个 3 小时期间，除了脉冲形状外，所有刺激参数均相同。在 3 小时期间，每小时评估一次震颤（Fahn-Tolosa-Marin 震颤评定量表）、共济失调（国际合作共济失调评定量表）和言语（声学和感知测量）。
结果
纳入 12 例 ET 患者。在 3 小时刺激期间，两种脉冲形状的震颤控制效果相当。双相脉冲引起的共济失调明显少于阴极脉冲（p=0.006）。双相脉冲的言语交替速率更好（p=0.048），但两种脉冲之间的其他构音障碍测量值没有显著差异。
结论
在 ET 患者接受 3 小时 DBS 刺激后，对称双相脉冲引起的共济失调比传统脉冲少。
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