关键词: Case report Deep brain stimulation Essential tremor Focused ultrasound Salvage therapy Thalamotomy

Mesh : Aged, 80 and over Deep Brain Stimulation / methods Essential Tremor / diagnostic imaging surgery Female Humans Recurrence Salvage Therapy / methods Treatment Outcome Ultrasonography, Interventional / methods Ventral Thalamic Nuclei / diagnostic imaging surgery

来  源:   DOI:10.1159/000486646

Abstract:
A recent randomized controlled trial investigating unilateral MRI-guided focused ultrasound (FUS) for essential tremor demonstrated efficacy. The long-term durability of this thalamotomy, however, is unknown. Furthermore, the feasibility of stimulating a previously lesioned target such as the thalamic nucleus ventralis intermedius (Vim) is poorly understood. We report a case of tremor recurrence, following an initially successful FUS thalamotomy, in which Vim-DBS was subsequently utilized to regain tremor control.
An 81-year-old right-handed female with medically refractory essential tremor (a Clinical Rating Scale for Tremor [CRST] value of 73) underwent left-sided FUS thalamotomy with initial abolition of right-upper extremity tremor. By the 6-month follow-up, there was complete recurrence of tremor (a CRST value of 76). The patient subsequently underwent left-sided Vim-DBS.
Vim-DBS provided clinical improvement with a CRST value of 42 at the 3-month follow-up; the patient continues to do clinically well at the 6-month follow-up. This result mirrors previous reported cases of stimulation following radiofrequency and gamma-knife lesioning. Our literature review highlights several reasons for the waning of clinical benefit seen with lesional procedures.
This case demonstrates that thalamic DBS can salvage a failed FUS thalamotomy and also the feasibility of stimulating a previously lesioned target.
摘要:
最近的一项随机对照试验研究了单侧MRI引导的聚焦超声(FUS)治疗特发性震颤的疗效。这种丘脑切开术的长期持久性,然而,是未知的。此外,刺激先前受损的目标,例如丘脑腹侧核(Vim)的可行性知之甚少。我们报告一例震颤复发,在最初成功的FUS丘脑切开术之后,其中Vim-DBS随后用于恢复震颤控制。
一名81岁的右撇子女性,患有难治性特发性震颤(震颤临床评定量表[CRST]值为73),接受了左侧FUS丘脑切开术,最初消除了右上肢震颤。通过6个月的随访,震颤完全复发(CRST值为76).患者随后接受左侧Vim-DBS。
Vim-DBS提供了临床改善,在3个月随访时CRST值为42;在6个月随访时,患者的临床状况继续良好。该结果反映了先前报道的射频和伽玛刀损伤后的刺激病例。我们的文献综述强调了病变手术临床获益减弱的几个原因。
该病例表明丘脑DBS可以挽救失败的FUS丘脑切开术,也可以刺激先前病变的目标。
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