Gelman Kate, Melott Joseph, Thakur Vishal, Tarabishy Abdul R, Brandt Ana, Konrad Peter, Ranjan Manish, Memon Adeel A
School of Medicine, West Virginia University, Morgantown, WV, United States.
Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.
Front Neurol. 2024 Feb 1;14:1331241. doi: 10.3389/fneur.2023.1331241. eCollection 2023.
Drug-induced tremor is a common side effect of lithium with an occurrence of approximately 25% of patients. Cessation of the offending drug can be difficult, and many medical treatments for drug-induced tremor are ineffective. Deep brain stimulation (DBS) has been shown in a limited number of case reports to effectively reduce drug-induced tremor, however, which remains an invasive therapeutic option. MR-guided focused ultrasound (MRgFUS) thalamotomy is an FDA-approved non-invasive treatment for essential tremor (ET). To the best of our knowledge, MRgFUS thalamotomy has never been reported to treat drug-induced tremor. Here, we present a case of a left-handed 55-year-old man with a progressive, medically refractory lithium-induced tremor of the bilateral upper extremities. The patient underwent MRgFUS thalamotomy targeting the right ventral intermediate nucleus (VIM) of the thalamus to treat the left hand. There was almost complete resolution of his left-hand tremor immediately following MRgFUS. There were no side effects. The patient continues to show excellent tremor control at 90-day follow-up and remains free from side effects. This case demonstrates MRgFUS thalamotomy as a possible novel treatment option to treat drug-induced tremor.
药物性震颤是锂盐常见的副作用，约25%的患者会出现。停用致病药物可能很困难，而且许多治疗药物性震颤的医学方法都无效。然而，在少数病例报告中显示，深部脑刺激（DBS）可有效减轻药物性震颤，不过这仍是一种侵入性治疗选择。磁共振引导聚焦超声（MRgFUS）丘脑切开术是一种经美国食品药品监督管理局（FDA）批准的用于治疗特发性震颤（ET）的非侵入性治疗方法。据我们所知，从未有过关于MRgFUS丘脑切开术治疗药物性震颤的报道。在此，我们报告一例55岁的左利手男性患者，患有双侧上肢进行性、药物难治性锂盐所致震颤。该患者接受了针对右侧丘脑腹中间核（VIM）的MRgFUS丘脑切开术以治疗左手震颤。MRgFUS术后，其左手震颤几乎完全消失。无副作用发生。在90天的随访中，患者的震颤控制情况良好，且仍无副作用。该病例表明，MRgFUS丘脑切开术可能是治疗药物性震颤的一种新的治疗选择。
