Harland Tessa, Sabourin Shelby, Mayer Ryan, Durphy Jennifer, Adam Octavian, Pilitsis Julie G
Department of Neurosurgery, Albany Medical Center, Albany , New York , USA.
Department of Experimental Therapeutics, Albany Medical Center, Albany , New York , USA.
Neurosurgery. 2024 Dec 12;97(1):259-263. doi: 10.1227/neu.0000000000003308.
Patients undergoing thalamic ventral intermediate nucleus stimulation to treat essential tremor (ET) develop tolerance over time, requiring higher stimulation amplitudes that lead to more frequent battery changes and suboptimal tremor control. The study objective is to determine whether amplitude tolerance differs between patients with omnidirectional vs directional leads.
We conducted a retrospective analysis of ET patients with omnidirectional and directional leads implanted between 2005 and 2022. We compared patient demographics, tremor scores, and energy utilization for directional and omnidirectional leads. Contact impedance was used to normalize amplitude values between groups. Analyses were duplicated after reclassifying omnidirectional and directional based on the utilization of directional programming for 2 or more years.
A total of 24 directional leads in 22 patients and 39 omnidirectional leads in 30 patients were followed for a mean of 3.71 and 7.54 years, respectively. There was no significant difference in age or baseline tremor scores between the groups. Both lead types demonstrated increasing amplitudes over time, but directional leads had significantly less change over time, particularly in the first year ( P = .0012). Patients with omnidirectional leads were more likely to experience a pulse width increase of greater than 20 µs over 1 year (41.0% vs 12.5%; P = .035). Although time to first implantable pulse generator replacement was shorter for directional leads, this was not significant ( P = .062).
Both omnidirectional and directional deep brain stimulation reduces tremor severity in ET patients. However, directional leads offer more stable voltage requirements and less year-to-year voltage change, particularly in the first year. The increased likelihood of significant pulse width changes in omnidirectional leads suggests that directional leads may provide more sustainable therapeutic effects through other programming parameters. Ongoing research is needed to optimize deep brain stimulation technology and programming strategies to maximize patient benefit and device longevity.
接受丘脑腹中间核刺激治疗特发性震颤（ET）的患者会随着时间推移产生耐受性，需要更高的刺激幅度，这会导致更频繁地更换电池以及震颤控制效果欠佳。本研究的目的是确定全向导联与定向导联患者之间的幅度耐受性是否存在差异。
我们对2005年至2022年间植入全向导联和定向导联的ET患者进行了回顾性分析。我们比较了定向导联和全向导联患者的人口统计学特征、震颤评分和能量利用情况。使用接触阻抗对组间幅度值进行标准化。在根据定向编程使用2年或更长时间对全向和定向进行重新分类后，重复进行分析。
共对22例患者的24根定向导联和30例患者的39根全向导联进行了随访，平均随访时间分别为3.71年和7.54年。两组患者的年龄或基线震颤评分无显著差异。两种导联类型的幅度均随时间增加，但定向导联随时间的变化明显较小，尤其是在第一年（P = 0.0012）。全向导联患者在1年内脉冲宽度增加大于20微秒的可能性更高（41.0%对12.5%；P = 0.035）。虽然定向导联首次更换可植入脉冲发生器的时间较短，但差异不显著（P = 0.062）。
全向和定向深部脑刺激均可降低ET患者的震颤严重程度。然而，定向导联提供更稳定的电压需求，且每年的电压变化较小，尤其是在第一年。全向导联中显著脉冲宽度变化的可能性增加表明，定向导联可能通过其他编程参数提供更可持续的治疗效果。需要持续开展研究以优化深部脑刺激技术和编程策略，从而使患者受益最大化并延长设备使用寿命。
