丘脑底后部与丘脑腹中间核脑深部电刺激治疗特发性震颤的疗效观察

Observation on the efficacy of electrical stimulation of the posterior subthalamic area and ventromedial nucleus of the thalamus in the treatment of essential tremor

目的观察分析丘脑底后部(PSA)脑深部电刺激(DBS)与丘脑腹中间核(Vim)DBS对特发性震颤(ET)患者运动和非运动症状的改善作用。方法纳入2018年11月至2022年4月于首都医科大学附属北京天坛医院神经外科学中心行PSA-DBS(5例)与Vim-DBS(9例)的患者进行回顾性研究。采用临床震颤评定量表(CRST)评估震颤症状(运动症状);采用ET生命质量调查问卷(QUEST)评价生命质量、采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评价患者的焦虑和抑郁情况、采用嗓音障碍指数量表(VHI)评价嗓音损伤情况(均为非运动症状)。比较两组患者术后末次随访上述指标的改善情况(P<0.05为差异有统计学意义)。结果两组患者术前上述指标的差异均无统计学意义(均P>0.05)。术后PSA-DBS组与Vim-DBS组的随访时间[M(Q_(1),Q_(3))]分别为18(14,30)个月、12(12,30)个月(P=0.245)。末次随访两组患者的CRST评分均较术前改善(均P<0.05),其中PSA-DBS组的改善率[M(Q_(1),Q_(3))]为64.3(56.0,85.4)%,Vim-DBS组为27.3(17.2,36.0)%,两组的差异有统计学意义(P=0.019)。PSA-DBS组的QUEST评分较术前改善(P=0.032),改善率[M(Q_(1),Q_(3))]为62.5(28.6,65.7)%;而Vim-DBS组的改善率为-4.17(-41.7,27.3)%,未较术前改善(P=0.487);两组比较,QUEST评分改善率的差异有统计学意义(P=0.042)。手术前、后PSA-DBS组与Vim-DBS组组内及组间的HAMA、HAMD及VHI评分比较,差异均无统计学意义(均P>0.05)。结论初步研究显示,PSA-DBS与Vim-DBS对ET患者的运动症状均有改善作用,但对非运动症状的疗效总体有限;PSA-DBS的总体疗效优于Vim-DBS。

Objective To observe and analyze the improvement effect of deep brain stimulation(DBS)of the posterior subthalamic area(PSA)and ventral intermediate nucleus of the thalamus(Vim)on motor and non-motor symptoms in patients with essential tremor(ET).Methods A retrospective study was conducted on patients who underwent PSA-DBS(5 cases)and Vim-DBS(9 cases)at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from November 2018 to April 2022.The Clinical Rating Scale for Tremor(CRST)was used to evaluate tremor symptoms(motor symptoms);the Quality of life in Essential Tremor Questionnaire(QUEST)was used to evaluate the quality of life,the Hamilton Anxiety Rating Scale(HAMA)and the Hamilton Depression Rating Scale(HAMD)were used to evaluate the patient's anxiety and depression respectively,and the Voice Handicap Index(VHI)was used to assess the voice impairment(all non-motor symptoms).We then compared the improvement of the above indicators between the two groups of patients before surgery and at the last follow-up after surgery,with P<0.05 indicating significant difference.Results There was no statistically significant difference in the above-mentioned indicators between the two groups of patients before surgery(all P>0.05).The median(Q_(1),Q_(3))follow-up time in the postoperative PSA-DBS group and Vim-DBS group were 18(14,30)months and 12(12,30)months respectively(P=0.245).At the final followup,the CRST scores of the two groups of patients were improved compared with those before surgery(both P<0.05).The median(Q_(1),Q_(3))improvement rate in the PSA-DBS group was 64.3%(56.0%,85.4%)and that in the Vim-DBS group was 27.3%(17.2%,36.0%),and the difference between the two groups was statistically significant(P=0.019).The QUEST score in the PSA-DBS group improved compared with preoperative period(P=0.032),with a median(Q_(1),Q_(3))improvement rate of 62.5%(28.6%,65.7%),while the improvement rate in the Vim-DBS group was-4.17%(-41.7%,27.3%),which was not improved compared with before surgery(P=0.487),and there was statistically significant difference in the improvement rate in QUEST score between the two groups(P=0.042).There was no significant diference in the intra-group and inter-group HAMA,HAMD and VHI scores between the PSA-DBS group and the Vim-DBS group before and after surgery(all P>0.05).Conclusion Preliminary research shows that both PSA-DBS and Vim-DBS can improve the motor symptoms of ET patients,but the overall effect on non-motor symptoms is not ideal.The overall effect of PSA-DBS seems superior to that of Vim-DBS.