微电极导向立体定向手术治疗原发性震颤

Neuroelectrophysiological basis and surgical treatment of essential tremor

目的 探讨丘脑腹外侧Vim核中与震颤症状相关的神经细胞电活动的规律 ,总结丘脑毁损术治疗原性震颤 (ET)的临床效果和安全性。方法 对 42例ET患者行单侧微电极导向的丘脑毁损术。采用FAHN的临床震颤评分法对其中 11例患者术前及术后进行定量评估和分析。结果 Vim核中神经细胞的簇状电活动节律与肢体震颤的节律有肯定的一致性 ,毁损这些与震颤症状相关的神经细胞后 ,所有ET患者手术对侧肢体的震颤完全消失 ;震颤的整体改善率 5 2 % ,特殊动作和功能改善率 5 4% ,功能残疾改善率 77% ;长期随访疗效稳定 ,其中 40例患者术后随访已 3个月以上 ,无复发 ;一过性并发症 12例 ,无永久性并发症发生。结论 丘脑的“震颤细胞”与ET患者的震颤症状密切相关 。

Objective To investigate the relationship between limb tremor and neuronal firing in thalamus (Vim) and retrospectively review the surgical treatment of essential tremor (ET) on clinical effects and safeness.Methods Forty-two ET patients received microelectrode-guided tha lamotomy and 11 cases was quantitatively evaluated with FAHN rating scales pre and post-operatively.Results There were electrophysiological tremor-related neurons in ventrolateral part of thelamus.Lesioning of those neurons abolished contralateral limb tremor in all of the patients.No permanent complications occurred.Conclusions 'Tremor cell'in thalamus plays a symptomatic key role in ET patients.Destruction of those cells may completely and permanently controls tremor symptom.