1Department of Neurosurgery, University of California, Los Angeles, California.
2University of Milan "LA STATALE," Milan, Italy.
Neurosurg Focus. 2024 Jun;56(6):E15. doi: 10.3171/2024.3.FOCUS2425.
Essential tremor (ET) is the most common movement disorder. Deep brain stimulation (DBS) targeting the ventral intermediate nucleus (VIM) is known to improve symptoms in patients with medication-resistant ET. However, the clinical effectiveness of VIM-DBS may vary, and other targets have been proposed. The authors aimed to investigate whether the same anatomical structure is responsible for tremor control both immediately after VIM-DBS and at later follow-up evaluations.
Of 68 electrodes from 41 patients with ET, the authors mapped the distances of the active contact from the VIM, the dentatorubrothalamic tract (DRTT), and the caudal zona incerta (cZI) and compared them using Friedman's ANOVA and the Wilcoxon signed-rank follow-up test. The same distances were also compared between the initially planned target and the final implantation site after intraoperative macrostimulation. Finally, the comparison among the three structures was repeated for 16 electrodes whose active contact was changed after a mean 37.5 months follow-up to improve tremor control.
After lead implantation, the VIM was statistically significantly closer to the active contact than both the DRTT (p = 0.008) and cZI (p < 0.001). This result did not change if the target was moved based on intraoperative macrostimulation. At the last follow-up, the active contact distance from the VIM was always significantly less than that of the cZI (p < 0.001), but the distance from the DRTT was reduced and even less than the distance from the VIM.
In patients receiving VIM-DBS, the VIM itself is the structure driving the anti-tremor effect and remains more effective than the cZI, even years after implantation. Nevertheless, the role of the DRTT may become more important over time and may help sustain the clinical efficacy when the habituation from the VIM stimulation ensues.
特发性震颤（ET）是最常见的运动障碍。已知针对腹侧中间核（VIM）的深部脑刺激（DBS）可改善药物抵抗性 ET 患者的症状。然而，VIM-DBS 的临床效果可能有所不同，并且已经提出了其他靶点。作者旨在研究在 VIM-DBS 后即刻和后续随访评估中，是否相同的解剖结构负责控制震颤。
在 41 名 ET 患者的 68 个电极中，作者绘制了活性接触点距 VIM、齿状核红核束（DRTT）和尾状核下区（cZI）的距离，并使用 Friedman 的 ANOVA 和 Wilcoxon 符号秩检验进行了比较。作者还比较了在术中宏观刺激后，最初计划的目标与最终植入部位之间的相同距离。最后，对于 16 个电极，在平均 37.5 个月的随访后，主动接触点发生了变化，以改善震颤控制，再次比较了这三个结构之间的关系。
在植入导丝后，VIM 与活性接触点的距离明显比 DRTT（p=0.008）和 cZI（p<0.001）更近。如果根据术中宏观刺激移动目标，该结果不会改变。在最后一次随访时，VIM 与活性接触点的距离始终明显小于 cZI（p<0.001），但 DRTT 的距离缩短，甚至小于 VIM 的距离。
在接受 VIM-DBS 的患者中，VIM 本身是驱动抗震颤效果的结构，即使在植入多年后，其效果仍优于 cZI。然而，随着时间的推移，DRTT 的作用可能变得更加重要，并且当 VIM 刺激的习惯形成时，它可以帮助维持临床疗效。
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