Observation on the efficacy of electrical stimulation of the posterior subthalamic area and ventromedial nucleus of the thalamus in the treatment of essential tremor
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,,Q3)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 follow-up,the CRST scores of the two groups of patients were improved compared with those before surgery(both P＜0.05).The median(Q,,Q3)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,,Q3)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 difference 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.
万方数据
维普
