Fixel Institute for Neurological Diseases Campus, University of Florida, Gainesville, FL, USA.
Department of Neurology, University of Florida, Gainesville, FL, USA.
Tremor Other Hyperkinet Mov (N Y). 2023 Aug 28;13:28. doi: 10.5334/tohm.780. eCollection 2023.
A 73-year-old woman with Parkinson's disease (PD) underwent implantation of bilateral subthalamic nucleus deep brain stimulators (STN-DBS) to address bilateral upper extremity medication-refractory tremor. Post-operatively, she experienced a "see-saw effect" where small increases in stimulation resulted in improvement in one symptom (tremor) with concurrent worsening in another (dyskinesia).
SID is usually considered a positive predictor of DBS outcome. However, there are cases where SID cannot be optimized. Lead location and pre-operative characteristics may contribute to this adverse effect. If the combination of programming and medication adjustments fails to resolve SID, what can be done to "rescue" the outcome?
Management of SID requires a gradual and steadfast programming approach. Post-operative lead localization can guide advanced programming and decision-making. Rescue surgical interventions may be considered.
In cases where SID is persistent despite deploying persistent optimization strategies, there is limited guidance on next steps.
一位 73 岁的帕金森病（PD）女性患者接受了双侧丘脑底核深部脑刺激器（STN-DBS）植入手术，以解决双侧上肢药物难治性震颤问题。术后，她出现了“跷跷板效应”，即刺激量稍有增加，震颤症状得到改善，但同时运动障碍也加重了。
SID 通常被认为是 DBS 治疗结果的积极预测因素。然而，也有一些情况下无法优化 SID。导联位置和术前特征可能导致这种不良反应。如果程控和药物调整的组合未能解决 SID，有什么方法可以“挽救”治疗结果？
SID 的管理需要采用渐进和坚定的程控方法。术后的导联定位可以指导更高级的程控和决策。可能需要考虑挽救性手术干预。
在尽管采用了持续优化策略但 SID 仍然持续存在的情况下，下一步的指导有限。
