Koller W, Pahwa R, Busenbark K, Hubble J, Wilkinson S, Lang A, Tuite P, Sime E, Lazano A, Hauser R, Malapira T, Smith D, Tarsy D, Miyawaki E, Norregaard T, Kormos T, Olanow C W
Department of Neurology, University of Kansas Medical Center, Kansas City 66160-7314, USA.
Ann Neurol. 1997 Sep;42(3):292-9. doi: 10.1002/ana.410420304.
Pharmacologic treatment for essential tremor and the tremor of Parkinson's disease is often inadequate. Stereotaxic surgery, such as thalamotomy, can effectively reduce tremors. We performed a multicenter trial of unilateral high-frequency stimulation of the ventral intermedius nucleus of the thalamus in 29 patients with essential tremor and 24 patients with Parkinson's disease, using a blinded assessment at 3 months after surgery to compare clinical rating of tremor with stimulation ON with stimulation OFF and baseline and a 1-year follow-up. Six patients were not implanted because of lack of intraoperative tremor suppression (2 patients), hemorrhage (2 patients), withdrawal of consent (1 patient), and persistent microthalamotomy effect (1 patient). A significant reduction in both essential and parkinsonian tremor occurred contralaterally with stimulation. Patients reported a significant reduction in disability. Measures of function were significantly improved in patients with essential tremor. Complications related to surgery in implanted patients were few. Stimulation was commonly associated with transient paresthesias. Other adverse effects were mild and well tolerated. Efficacy was not reduced at 1 year. Chronic high-frequency stimulation is safe and highly effective in ameliorating essential and parkinsonian tremor.
特发性震颤和帕金森病震颤的药物治疗往往效果不佳。立体定向手术，如丘脑切开术，可有效减轻震颤。我们对29例特发性震颤患者和24例帕金森病患者进行了一项丘脑腹中间核单侧高频刺激的多中心试验，术后3个月采用盲法评估，比较刺激开启与关闭时以及基线时的震颤临床评分，并进行1年随访。6例患者因术中震颤未得到抑制（2例）、出血（2例）、撤回同意（1例）和丘脑切开术效果持续存在（1例）而未植入。刺激时，对侧的特发性震颤和帕金森病震颤均显著减轻。患者报告残疾显著减轻。特发性震颤患者的功能指标有显著改善。植入患者的手术相关并发症较少。刺激通常伴有短暂性感觉异常。其他不良反应轻微，耐受性良好。1年时疗效未降低。慢性高频刺激在改善特发性震颤和帕金森病震颤方面安全且高效。
