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.
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。