Nagel Johanna M, Wolf Marc E, Blahak Christian, Runge Joachim, Schrader Christoph, Dressler Dirk, Saryyeva Assel, Krauss Joachim K
Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
Mov Disord Clin Pract. 2025 Aug 27. doi: 10.1002/mdc3.70266.
Dystonic head tremor is a particular manifestation of dystonia, which is difficult to treat. Although deep brain stimulation (DBS) of the globus pallidus internus has been established as a treatment for different phenotypes of dystonia, its role in dystonic tremor has been debated. Although thalamic targets have been used for treatment of dystonic tremor of the extremities, there is limited experience with dystonic head tremor.
Here, we present our experience with thalamic ventral intermediate (Vim) nucleus DBS in a consecutive series of patients providing long-term follow-up.
Eighteen patients with dystonic head tremor as the leading symptom underwent the implantation of quadripolar DBS electrodes into the thalamic Vim. Patients' symptoms were evaluated with the Burke-Fahn-Marsden Dystonia Rating Scale motor (BFMDRS-M) and disability (BFMDRS-D) scores, and a modified Fahn-Tolosa-Marin Tremor Rating Scale (mFTMTRS), preoperatively, at short-term (3 months-2 years), and at long-term follow-up (>2 years).
There was improvement in both tremor and dystonia rating scales. Tremor scores were reduced from a value of 7.94 preoperatively to 2.0 at short term (P < 0.001) and to 1.71 at long-term follow-up (P < 0.001). BFMDRS-M scores were reduced from 14.56 to 7.8 (P < 0.001) and to 7.0 (P < 0.001), and BFMDRS-D scores from 3.88 to 2.65 (P < 0.05) and to 2.71 (P < 0.05), respectively, during chronic stimulation.
Our results indicate that Vim DBS is a safe and efficient treatment option for dystonic head tremor with stable long-term results. We suggest Vim DBS as an alternative to pallidal DBS in cases where head tremor is the leading symptom.
肌张力障碍性头部震颤是肌张力障碍的一种特殊表现形式，难以治疗。尽管内侧苍白球的深部脑刺激（DBS）已被确立为治疗不同表型肌张力障碍的方法，但其在肌张力障碍性震颤中的作用一直存在争议。虽然丘脑靶点已被用于治疗肢体的肌张力障碍性震颤，但在肌张力障碍性头部震颤方面的经验有限。
在此，我们介绍在一系列接受长期随访的患者中使用丘脑腹中间核（Vim）进行DBS的经验。
18例以肌张力障碍性头部震颤为主要症状的患者接受了四极DBS电极植入丘脑Vim。术前、短期（3个月至2年）和长期随访（>2年）时，使用伯克-法恩-马斯登肌张力障碍评定量表运动（BFMDRS-M）和残疾（BFMDRS-D）评分以及改良的法恩-托洛萨-马林震颤评定量表（mFTMTRS）对患者症状进行评估。
震颤和肌张力障碍评定量表均有改善。震颤评分从术前的7.94降至短期的2.0（P<0.001）和长期随访时的1.71（P<0.001）。慢性刺激期间，BFMDRS-M评分分别从14.56降至7.8（P<0.001）和7.0（P<0.001），BFMDRS-D评分从3.88降至2.65（P<0.05）和2.71（P<0.05）。
我们的结果表明，Vim DBS是治疗肌张力障碍性头部震颤的一种安全有效的治疗选择，长期效果稳定。我们建议在以头部震颤为主要症状的病例中，Vim DBS可作为苍白球DBS的替代方法。
