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首页> 外文期刊>Archives of Neurology >Thalamic deep brain stimulation: comparison between unilateral and bilateral placement.
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Thalamic deep brain stimulation: comparison between unilateral and bilateral placement.

机译：丘脑脑深部刺激:比较单边和双边之间的位置。

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BACKGROUND: Unilateral thalamic deep brain stimulation (DBS) is accepted as an effective treatment for essential tremor (ET) and the tremor of Parkinson disease (PD). There are, however, relatively little data concerning bilateral thalamic DBS and no thorough comparisons between the 2 methods. METHODS: To assess the relative benefit of a staged second contralateral DBS placement in patients with PD and ET, we compared preoperative baseline assessments with those at 3 months after the initial implantation, and again at 3 months after the second contralateral implantation. The assessments included the Unified Parkinson's Disease Rating Scale for patients with PD (n = 8) and a modified Unified Tremor Rating Assessment for patients with ET (n = 13). The design included open and blinded (unknown activation status) assessments. RESULTS: Overall, after the second implantation, all specific measures assessing tremor contralateral to that side improved in patients with PD and ET, generally without sacrificing those contralateral to the first side implantation. Midline tremors (face and head) improved only after the second side implantation. In patients with ET, functional and subjective scores tended to further improve after the second placement; however, patients with PD had less subjective improvement. Hand tremor scores in patients with ET randomized to "on" stimulation improved from 6.7 +/- 0.9 to 1.3 +/- 1.2 (P<.005). The scores of patients with PD randomized to on stimulation improved from 9.3 +/- 1.0 to 1.0 +/- 0.5. (Data are given as mean +/- SD.) Tremor scores did not change from baseline in those patients randomized to "off" stimulation in either group. Adverse events related to stimulation increased after the second implantation in both groups. CONCLUSIONS: Bilateral thalamic DBS is more effective than unilateral DBS at controlling bilateral appendicular and midline tremors of ET and PD. Despite this, overall functional disability only improved in patients with ET, possibly secondary to more problematic adverse events in patients with PD, especially balance problems. Bilateral DBS should be considered when unilateral DBS does not offer satisfactory benefit, especially in patients with ET.
机译：背景:单边丘脑脑深部刺激(DBS)被接受为一个有效的治疗特发性震颤(ET)和帕金森病(PD)的震颤。然而,相对较少的数据有关双边丘脑DBS和不彻底的2方法之间的比较。评估上演第二相对的好处侧DBS在PD患者等,我们比较术前基线和那些在3个月后评估最初的植入,并在3个月后再次第二侧注入。评估包括统一帕金森症PD患者的疾病评定量表(n = 8)统一的地震等级评估和修改患者ET (n = 13)。包括开放和失明(未知的激活状态)评估。第二次植入,所有的具体措施评估地震侧到一边改善PD患者和等,一般在不牺牲那些侧第一次移植。和头部)只有在第二次改善植入。主观分数后倾向于进一步提高第二个位置;减少了主观的改进。分数ET患者随机分配到“on”刺激改善从6.7 + / - 0.9 + / - 1.31.2 (P < .005)。随机从9.3上刺激改善+ / - 1.0到1.0 + / - 0.5。+ / - SD)。基线在这些患者随机分配到“关闭”刺激在两组。有关刺激增加了第二次在两组植入。双边丘脑DBS是更有效的比单边DBS在控制中附属物的中线的震动等和PD。尽管如此,总体功能残疾改善患者等,可能是次要的有问题的不良事件的患者PD,特别是平衡问题。星展银行单方面DBS时应该考虑的没有提供满意的利益,特别是在等患者。

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