The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK; University of Liverpool Medical School, Liverpool, UK.
The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK.
J Neurol Sci. 2024 Feb 15;457:122887. doi: 10.1016/j.jns.2024.122887. Epub 2024 Jan 26.
Essential tremor (ET) is characterized by action tremor of the upper limbs, head tremor and voice tremor. Dystonic tremor (DT) is produced by muscle contractions in a body affected by dystonia. Deep brain stimulation (DBS) of ventral intermediate nucleus of the thalamus (VIM) is the most well-known advanced treatment for medication-refractory tremor. However, decline in efficacy overtime has led to explore other targets. This study aimed to measure the efficacy of bilateral dual targeting ViM/caudal Zona Incerta (cZI) stimulation on tremor control. A secondary aim was to evaluate if there was a difference in the efficacy between ET and DT.
36 patients were retrospectively recruited at the Walton NHS Foundation Trust, Liverpool, UK. Patients were assessed pre-operatively, and then at 1-year, 3-years, and 5-years post-operatively with the following scales: Fahn-Tolosa-Marin tremor rating (FTMTR) scale, EuroQol-5D, and Hospital Anxiety and Depression Scale.
Bilateral ViM-cZI DBS significantly improved overall tremor score by 45.1% from baseline to 3-years post-operatively (p < 0.001). It continued to show improvement in overall FTMTR score by 30.7% at 5-years but this failed to meet significance. However, there was no significant improvement of mood or quality of life (QoL) scores. ET group on average showed a significant better clinical outcome compared to the DT group (p > 0.001).
Our study found that bilateral ViM-cZI DBS treatment had a favourable effect on motor symptoms sustained over the 5-years in tremor patients, especially in ET group. There was limited effect on mood and QoL with similar trends in outcomes for both tremor types.
特发性震颤（ET）的特征是上肢、头部和声音震颤。肌张力障碍性震颤（DT）是由受肌张力障碍影响的身体的肌肉收缩产生的。丘脑腹中间核（VIM）的深部脑刺激（DBS）是治疗药物难治性震颤最著名的先进治疗方法。然而，随着时间的推移，疗效的下降导致了对其他靶点的探索。本研究旨在测量双侧双靶点 VIM/尾状核下区（cZI）刺激对震颤控制的疗效。次要目的是评估 ET 和 DT 之间的疗效是否存在差异。
36 例患者在英国利物浦的沃尔顿国民保健信托基金会（Walton NHS Foundation Trust）接受回顾性招募。患者在术前、术后 1 年、3 年和 5 年进行以下评估：Fahn-Tolosa-Marin 震颤评定量表（FTMTR）、欧洲五维健康量表（EuroQol-5D）和医院焦虑抑郁量表。
双侧 VIM-cZI DBS 可显著改善震颤总评分，术后 3 年时与基线相比改善 45.1%（p<0.001）。5 年时，震颤总评分继续改善 30.7%，但未达到显著水平。然而，情绪或生活质量（QoL）评分无显著改善。与 DT 组相比，ET 组的平均临床疗效显著更好（p>0.001）。
我们的研究发现，双侧 VIM-cZI DBS 治疗对震颤患者的运动症状具有持续 5 年的有利影响，尤其是在 ET 组。对情绪和 QoL 的影响有限，两种震颤类型的结果趋势相似。
