目的:原发性震颤(ET)是最常见的运动障碍。已知针对腹侧中间核(VIM)的深部脑刺激(DBS)可以改善耐药ET患者的症状。然而,VIM-DBS的临床疗效可能有所不同,并提出了其他目标。作者旨在研究相同的解剖结构是否在VIM-DBS后立即控制震颤以及随后的随访评估。
方法:对41例ET患者的68个电极,作者绘制了活动联系人与VIM的距离,齿托溴丘脑道(DRTT),和尾带不确定(cZI),并使用Friedman的方差分析和Wilcoxon符号秩随访检验进行比较。术中宏观刺激后,还比较了最初计划的目标和最终植入部位之间的相同距离。最后,对16个电极重复三种结构之间的比较,这些电极的活性接触在平均37.5个月的随访后改变,以改善震颤控制.
结果:导线植入后,与DRTT(p=0.008)和cZI(p<0.001)相比,VIM在统计学上更接近主动接触.如果基于术中宏观刺激来移动目标,则该结果没有改变。在最后一次随访中,与VIM的主动接触距离始终显著小于与CZI的主动接触距离(p<0.001),但是与DRTT的距离减少了,甚至小于与VIM的距离。
结论:在接受VIM-DBS的患者中,VIM本身是驱动抗震颤效果的结构,并且比cZI更有效,甚至在植入后几年。然而,随着时间的推移,DRTT的作用可能变得更加重要,并且当VIM刺激产生习惯时,DRTT的作用可能有助于维持临床疗效.
Essential tremor (ET) is the most common movement disorder. Deep brain stimulation (DBS) targeting the ventral intermediate nucleus (VIM) is known to improve symptoms in patients with medication-resistant ET. However, the clinical effectiveness of VIM-DBS may vary, and other targets have been proposed. The authors aimed to investigate whether the same anatomical structure is responsible for tremor control both immediately after VIM-DBS and at later follow-up evaluations.
Of 68 electrodes from 41 patients with ET, the authors mapped the distances of the active contact from the VIM, the dentatorubrothalamic tract (DRTT), and the caudal zona incerta (cZI) and compared them using Friedman\'s ANOVA and the Wilcoxon signed-rank follow-up test. The same distances were also compared between the initially planned target and the final implantation site after intraoperative macrostimulation. Finally, the comparison among the three structures was repeated for 16 electrodes whose active contact was changed after a mean 37.5 months follow-up to improve tremor control.
After lead implantation, the VIM was statistically significantly closer to the active contact than both the DRTT (p = 0.008) and cZI (p < 0.001). This result did not change if the target was moved based on intraoperative macrostimulation. At the last follow-up, the active contact distance from the VIM was always significantly less than that of the cZI (p < 0.001), but the distance from the DRTT was reduced and even less than the distance from the VIM.
In patients receiving VIM-DBS, the VIM itself is the structure driving the anti-tremor effect and remains more effective than the cZI, even years after implantation. Nevertheless, the role of the DRTT may become more important over time and may help sustain the clinical efficacy when the habituation from the VIM stimulation ensues.