Quantification of temporal and spatial accuracy of alternating arm movements in multiple sclerosis patients treated with deep brain stimulation of the thalamic ventralis intermedius nucleus (VIM).

J Spiegel, U Dillmann, J R Moringlane
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引用次数: 3

Abstract

Objective: In patients with multiple sclerosis (MS) ataxia is a common symptom, which is barely influenced by pharmacological treatment. We studied whether stimulation of the thalamic ventralis intermedius nucleus (VIM) improves the performance of alternating forearm movements in MS patients.

Methods: We investigated 6 patients with primary (n=1) or secondary (n=5) chronic progressive MS (age 36-66 years, median 41.5 years, median EDSS [expanded disability status scale] 6.5). Patients were seated in a chair with one arm abduced at right angles to the body. This arm was strapped into a splint with one fixed section for the upper arm and one movable section for the forearm. The latter allowed horizontal movements in the elbow joint. The patients had to perform rhythmic alternating flexion and extension movements in the elbow joint. The rhythm and spatial extent of movements were indicated acoustically by a click tone stimulator and by marks respectively. Six manoeuvres (spatial extents of 48 degrees , 83 degrees at frequencies of 0.9 Hz, 1.5 Hz, and 2.5 Hz each) had to be performed. A potentiometer converted the horizontal movements of the forearm into a variable voltage. Forearm movements were measured with and without contralateral VIM stimulation.

Results: In all patients, spatial accuracy of the alternating forearm movements improved significantly after the stimulation had been switched on. Temporal accuracy increased during VIM stimulation in 5 of 6 patients. In 1 of 6 patients the spatial but not the temporal movement accuracy improved during stimulation.

Conclusions: During VIM stimulation, performance of alternating forearm movements improved significantly. This might indicate that VIM stimulation could be a therapeutic alternative in the treatment of upper limb ataxia in MS.

脑深部刺激丘脑正中腹侧核(VIM)治疗多发性硬化症患者交替手臂运动时间和空间准确性的量化。
目的:多发性硬化症(MS)患者共济失调是一种常见的症状,药物治疗对其影响不大。我们研究了刺激丘脑腹侧中间核(VIM)是否能改善MS患者前臂交替运动的表现。方法:我们调查了6例原发性(n=1)或继发性(n=5)慢性进展性MS患者(年龄36-66岁,中位41.5岁,中位EDSS[扩展残疾状态量表]6.5)。患者坐在椅子上,一只手臂外展,与身体成直角。这只手臂被绑在一个夹板上,一个固定的部分用于上臂,一个活动的部分用于前臂。后者允许肘关节水平运动。患者必须在肘关节进行有节奏的交替屈伸运动。运动的节奏和空间范围分别由一个点击音刺激器和标记来指示。必须执行6个操作(48度,83度的空间范围,频率分别为0.9 Hz, 1.5 Hz和2.5 Hz)。电位器将前臂的水平运动转换成可变电压。在有和没有对侧VIM刺激的情况下测量前臂运动。结果:所有患者在刺激开启后,前臂交替运动的空间准确性显著提高。6例患者中有5例在VIM刺激时时间准确性增加。6例患者中有1例在刺激过程中空间运动精度提高,而时间运动精度没有提高。结论:在VIM刺激下,前臂交替运动的表现明显改善。这可能表明VIM刺激可能是治疗MS上肢共济失调的一种治疗选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Zentralblatt Fur Neurochirurgie
Zentralblatt Fur Neurochirurgie 医学-神经科学
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