Abstract：
BACKGROUND: Midline Tremor is defined as an isolated or combined tremor that affects the neck, trunk, jaw, tongue, and/or voice and could be part of Essential Tremor (ET), or dystonic tremor. The clinical efficacy of deep brain stimulation for Midline Tremor has been rarely reported. The Ventral Intermediate Nucleus and Globus Pallidus Internus are the preferred targets, but with variable outcomes. Thalamic Ventral-Oralis (VO) complex and Zona Incerta (ZI) are emerging targets for tremor control in various etiologies.
OBJECTIVE: To report on neuroradiological, neurophysiological targeting and long-term efficacy of thalamic Ventral-Oralis complex and Zona Incerta deep brain stimulation in Midline Tremor.
METHODS: Three patients (two males and one female) with Midline Tremor in dystonic syndromes were recruited for this open-label study. Clinical, surgical, neurophysiological intraoperative testing and long-term follow-up data are reported.
RESULTS: Intraoperative testing and reconstruction of volume of tissue activated confirmed the position of the electrodes in the area stimulated between the thalamic Ventral-Oralis complex and Zona Incerta in all patients. All three patients showed optimal control of both tremor and dystonic features at short-term (6 months) and long-term follow-up (up to 6 years). No adverse events occurred.
CONCLUSIONS: In the syndromes of Midline Tremor of various origins, the best target for DBS might be difficult to identify. Our results showed that thalamic Ventral-Oralis complex/Zona Incerta may be a viable and safe option even in specific forms of tremor with axial distribution.
OBJECTIVE: To report on neuroradiological, neurophysiological targeting and long-term efficacy of thalamic Ventral-Oralis complex and Zona Incerta deep brain stimulation in Midline Tremor.
METHODS: Three patients (two males and one female) with Midline Tremor in dystonic syndromes were recruited for this open-label study. Clinical, surgical, neurophysiological intraoperative testing and long-term follow-up data are reported.
RESULTS: Intraoperative testing and reconstruction of volume of tissue activated confirmed the position of the electrodes in the area stimulated between the thalamic Ventral-Oralis complex and Zona Incerta in all patients. All three patients showed optimal control of both tremor and dystonic features at short-term (6 months) and long-term follow-up (up to 6 years). No adverse events occurred.
CONCLUSIONS: In the syndromes of Midline Tremor of various origins, the best target for DBS might be difficult to identify. Our results showed that thalamic Ventral-Oralis complex/Zona Incerta may be a viable and safe option even in specific forms of tremor with axial distribution.
摘要：
背景：中线震颤被定义为影响颈部的孤立或合并震颤，树干,下巴,舌头,和/或声音，可能是原发性震颤(ET)的一部分，或者肌张力障碍震颤.脑深部电刺激治疗中线震颤的临床疗效鲜有报道。腹侧中间核和GlobusPallidusInternus是首选靶标，但结果可变。丘脑腹口（VO）复合体和ZonaIncerta（ZI）是各种病因中控制震颤的新兴目标。
目的：报告神经放射学，丘脑腹口复合体和ZonaIncerta深部脑刺激在中线震颤中的神经生理学靶向和长期疗效。
方法：招募了3名患有肌张力障碍综合征中线震颤的患者（2名男性和1名女性）进行这项开放标签研究。临床,外科,报告了神经生理学术中检测和长期随访数据.
结果：术中测试和激活的组织体积的重建证实了所有患者在丘脑腹侧-口腔复合体和ZonaIncerta之间刺激的区域中电极的位置。在短期（6个月）和长期随访（长达6年）中，所有三名患者均表现出对震颤和肌张力障碍特征的最佳控制。无不良事件发生。
结论：在各种起源的中线震颤综合征中，DBS的最佳目标可能很难确定。我们的结果表明，即使在具有轴向分布的特定形式的震颤中，丘脑腹侧-Oralis复合体/ZonaIncerta也可能是可行且安全的选择。
目的：报告神经放射学，丘脑腹口复合体和ZonaIncerta深部脑刺激在中线震颤中的神经生理学靶向和长期疗效。
方法：招募了3名患有肌张力障碍综合征中线震颤的患者（2名男性和1名女性）进行这项开放标签研究。临床,外科,报告了神经生理学术中检测和长期随访数据.
结果：术中测试和激活的组织体积的重建证实了所有患者在丘脑腹侧-口腔复合体和ZonaIncerta之间刺激的区域中电极的位置。在短期（6个月）和长期随访（长达6年）中，所有三名患者均表现出对震颤和肌张力障碍特征的最佳控制。无不良事件发生。
结论：在各种起源的中线震颤综合征中，DBS的最佳目标可能很难确定。我们的结果表明，即使在具有轴向分布的特定形式的震颤中，丘脑腹侧-Oralis复合体/ZonaIncerta也可能是可行且安全的选择。
