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Outcomes and Adverse Effects of Deep Brain Stimulation on the Ventral Intermediate Nucleus in Patients with Essential Tremor.
Neural Plasticity ( IF 3.1 ) Pub Date : 2020-08-01 , DOI: 10.1155/2020/2486065
Guohui Lu 1 , Linfeng Luo 2 , Maolin Liu 2 , Zijian Zheng 2 , Bohan Zhang 2 , Xiaosi Chen 2 , Xing Hua 2 , Houyou Fan 2 , Guoheng Mo 3 , Jian Duan 1 , MeiHua Li 1 , Tao Hong 1 , Dongwei Zhou 1
Affiliation  

Objective. This study was aimed at identifying the potential outcome predictors, comparing the efficacy in patients with different tremor characteristics, and summarizing the adverse effect rates (AERs) of deep brain stimulation on the ventral intermediate nucleus (VIM-DBS) for essential tremor (ET). Methods. An extensive search of articles published to date in 2019 was conducted, and two main aspects were analyzed. Improvement was calculated as a percentage of change in any objective tremor rating scale (TRS) and analyzed by subgroup analyses of patients’ tremor characteristics, laterality, and stimulation parameters. Furthermore, the AERs were analyzed as follows: the adverse effects (AEs) were classified as stimulation-related, surgical-related, or device-related effects. A simple regression analysis was used to identify the potential prognostic factors, and a two-sample mean-comparison test was used to verify the statistical significance of the subgroup analyses. Results. Forty-six articles involving 1714 patients were included in the meta-analysis. The pooled improvement in any objective TRS score was 61.3% (95% CI: 0.564-0.660) at the mean follow-up visit ( months). The midline and extremity symptoms showed consistent improvement (), and the results of the comparison of postural and kinetic tremor were the same (). In addition, the improvement in rest tremor was similar to that in action tremor (, ). In the simple regression analysis, the preoperative Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS) scores and follow-up time were negatively correlated with the percentage change in any objective TRS score (). The most common adverse event was dysarthria (10.5%), which is a stimulation-related AE (23.6%), while the rates of the surgical-related and device-related AEs were 6.4% and 11.5%, respectively. Conclusion. VIM-DBS is an efficient and safe surgical method in ET, and the efficacy was not affected by the body distribution of tremor, age at surgery, and disease duration. Lower preoperative FTM-TRS scores likely indicate greater improvement, and the effect of VIM-DBS declines over time.

中文翻译:

深部脑刺激对原发性震颤患者腹侧中间核的结果和不良反应。

目标。这项研究旨在确定潜在的结果预测指标,比较不同震颤特征的患者的疗效,并总结深部脑刺激对原发性震颤(ET)的腹侧中间核(VIM - DBS)的不良反应率(AER ) 。方法。对2019年迄今发表的文章进行了广泛搜索,并分析了两个主要方面。以任何客观震颤等级量表(TRS)的变化百分比计算改善,并通过对患者震颤特征,偏侧性和刺激参数的亚组分析进行分析。此外,对AER进行了如下分析:不良反应(AE)分为刺激相关,手术相关或设备相关的影响。使用简单的回归分析来确定潜在的预后因素,并使用两次样本均值比较检验来验证亚组分析的统计学意义。结果。荟萃分析包括46篇涉及1714例患者的文章。在平均随访期间,任何客观TRS评分的综合改善为61.3%(95%CI:0.564-0.660)(个月)。中线和四肢症状持续改善(),并且姿势性和运动性震颤的比较结果相同()。此外,静息性震颤的改善与动作性震颤相似( )。在简单的回归分析中,术前Fahn-Tolosa-Marin震颤评分量表(FTM-TRS)得分和随访时间与任何客观TRS得分的百分比变化呈负相关()。最常见的不良事件是构音障碍(10.5%),这是一种与刺激有关的AE(23.6%),而与手术有关的AE和与器械有关的AE的发生率分别为6.4%和11.5%。结论。VIM - DBS是ET中一种安全有效的手术方法,其功效不受震颤的身体分布,手术年龄和疾病持续时间的影响。较低的术前FTM-TRS分数可能表明有更大的改善,并且VIM-DBS的效果会随着时间而下降。
更新日期:2020-08-01
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