丘脑深部脑刺激与磁共振引导聚焦超声治疗震颤患者：回顾性单外科医生比较。

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY

Movement Disorders Pub Date : 2025-02-27 DOI:10.1002/mds.30153

Christian Rainer Baumann MD, Andreas Fleisch MD, Sujitha Mahendran MD, Mechtild Uhl ADN, Carola Freudinger ADN, Evdokia Efthymiou MD, Markus Florian Oertel MD, Lennart Henning Stieglitz MD, Fabian Büchele MD

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引用次数: 0

摘要

背景：双侧深部脑刺激（DBS）和单侧磁共振引导聚焦超声（MRgFUS）是目前治疗耐药震颤的两种最成熟的干预措施，未来可能会有针对丘脑腹侧中间核（VIM）的第二侧治疗，但由于缺乏比较证据，治疗选择受到阻碍。目的：首次对双侧VIM-DBS和单侧VIM-MRgFUS进行中心内和手术内的直接比较，采用一致的时间和详细的疗效和安全性评估。方法：在这项回顾性研究中，我们纳入了2014年至2022年间由一名神经外科医生接受双侧VIM-DBS （n = 30）或单侧VIM-MRgFUS （n = 52）的患者。疗效主要通过华盛顿高地-因伍德基因研究特发性震颤量表在6个月时的改善程度来衡量。关于安全性，我们比较了治疗、程序和硬件相关不良事件（ae），根据对日常生活活动的影响（adl）和严重ae （SAEs）进行分级，严重ae是基于长期/重复住院或影响adl的持续症状进行回顾性定义的。结果：我们发现受影响更严重的手的震颤减少(DBS: 62.4% [41.3-87.9], MRgFUS: 69.4% [42.4-77.7]；P = 0.958)，但只有双侧DBS才能改善对侧和轴向震颤。DBS与较高的手术和硬件相关ae发生率相关(17% vs. 2%；P = 0.023)，但6个月时持续治疗相关不良事件影响ADLs的发生率无显著降低(7% vs. 13%；p = 0.343)。总体而言，SAEs发生率(23.3% vs. 19.2%；P = 0.779)和持续缺陷在6个月时影响ADLs (10% vs 13%；P = 0.82)相似。结论：尽管安全性不同，但两种干预措施产生的不良反应负担相似。震颤控制在更受影响的一侧是相同的，而对侧和轴向震颤只有在双侧DBS后才得到改善。©2025国际帕金森和运动障碍学会。

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Thalamic Deep Brain Stimulation Versus Magnetic Resonance–Guided Focused Ultrasound in Tremor Patients: A Retrospective Single-Surgeon Comparison

Background

Bilateral deep brain stimulation (DBS) and unilateral magnetic resonance–guided focused ultrasound (MRgFUS), with potential future second-side treatment targeting the thalamic ventral intermediate nucleus (VIM), are currently the two best-established interventions for pharmaco-resistant tremors, but treatment selection is hampered by the lack of comparative evidence.

Objective

To provide the first direct within-center and within-surgeon comparison between bilateral VIM-DBS and unilateral VIM-MRgFUS, applying consistently timed and elaborated efficacy and safety assessements.

Methods

In this retrospective study, we included patients having received bilateral VIM-DBS (n = 30) or unilateral VIM-MRgFUS (n = 52) performed by one single neurosurgeon between 2014 and 2022. Efficacy was primarily measured by the improvement of the Washington Heights-Inwood Genetic Study of Essential Tremor scale in the more affected hand at 6 months. Regarding safety, we compared treatment-, procedure-, and hardware-related adverse events (AEs), graded by impact on activities of daily living (ADLs), and serious AEs (SAEs), retrospectively defined based on prolonged/repeated hospitalizations or persistent symptoms affecting ADLs.

Results

We found equivalent tremor reduction in the more affected hand (DBS: 62.4% [41.3–87.9] vs. MRgFUS: 69.4% [42.4–77.7]; P = 0.958), but contralateral and axial tremors improved only with bilateral DBS. DBS was associated with a higher rate of procedure- and hardware-related AEs (17% vs. 2%; P = 0.023) but a nonsignificantly lower rate of persistent treatment-related AEs affecting ADLs at 6 months (7% vs. 13%; P = 0.343). Overall, the rates of SAEs (23.3% vs. 19.2%; P = 0.779) and persistent deficits affecting ADLs at 6 months (10% vs. 13%; P = 0.82) were similar.

Conclusions

Despite distinct safety profiles, both interventions produced a similar burden of AEs. Tremor control was equivalent on the more affected side, whereas contralateral and axial tremors improved only after bilateral DBS. © 2025 International Parkinson and Movement Disorder Society.

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.