Bilateral thalamic deep brain stimulation: midline tremor control
J D Putzke, R J Uitti, A A Obwegeser, Z K Wszolek, R E Wharen, J D Putzke, R J Uitti, A A Obwegeser, Z K Wszolek, R E Wharen
Abstract
Objectives: To determine the efficacy of bilateral deep brain stimulation (DBS) for management of midline tremor (head, voice, tongue, trunk) in patients with essential tremor.
Design: Prospective assessment of tremor at baseline (presurgical), and postoperatively at 1, 3, and 12 months, and annually thereafter.
Methods: A clinical series of 22 individuals undergoing staged, bilateral DBS for treatment of essential tremor. The tremor rating scale was the primary outcome measure.
Results: Midline tremor showed significant improvement with stimulation "on" at nearly every postoperative interval when compared with stimulation "off" and with baseline tremor. Bilateral stimulation was associated with a significant incremental improvement in midline tremor control compared with unilateral stimulation: average "stimulation on" percentage change in midline tremor from the unilateral to bilateral period was 81%. Head and voice tremor showed the most consistent improvement. Among those requiring a change in stimulation parameters because of side effects, dysarthria, disequilibrium, motor disturbances, and paraesthesiae were the most common. Dysarthria was more common with bilateral (n = 6; 27%) than with unilateral (n = 0) stimulation. Stimulation parameters remained largely unchanged after the first three months. Nine of 44 leads placed (20%) required subsequent repositioning or replacement.
Conclusions: Unilateral thalamic stimulation significantly improves midline tremor, and subsequent bilateral thalamic stimulation offers an additional incremental improvement in midline tremor control.
References
- Neurology. 1999 Oct 22;53(7):1447-50
- Mov Disord. 1999 Sep;14(5):847-50
- Neurology. 2000;54(11 Suppl 4):S2-6
- Neurology. 2000;54(11 Suppl 4):S8-S13
- Stereotact Funct Neurosurg. 1999;72(2-4):208-18
- Neurology. 2000 Jun 27;54(12):2342-4
- Mayo Clin Proc. 2001 Jan;76(1):87-9
- Neurology. 2000;55(12 Suppl 6):S13-6
- Arch Neurol. 2001 Feb;58(2):218-22
- Neurosurgery. 2001 Feb;48(2):274-81; discussion 281-4
- Mov Disord. 2001 May;16(3):464-8
- Neurology. 2001 Aug 28;57(4):663-71
- Mov Disord. 2001 Nov;16(6):1137-42
- Can J Neurol Sci. 2004 Aug;31(3):333-42
- J Neurosurg. 1992 Jul;77(1):62-8
- J Neurosurg. 1996 Feb;84(2):203-14
- Neurology. 1998 Mar;50(3):796-8
- Arch Neurol. 1998 Jun;55(6):823-8
- J Neurol Neurosurg Psychiatry. 1999 Mar;66(3):289-96
- J Neurosurg. 1999 Jul;91(1):68-72
- Neurology. 1999 Aug 11;53(3):561-6
- Stereotact Funct Neurosurg. 1999;72(1):47-61
Source: PubMed