Radiofrequency Lesions through Deep Brain Stimulation Electrodes in Movement Disorders: Case Report and Review of the Literature

Pérez-Suárez, Javier; Torres, Cristina V.; Manzanares, Lydia López; García, Marta Navas; Pastor, Jesús; Fernández, Patricia Barrio; Sola, Rafael G.

doi:10.1159/000454891

Cited by 8 publications

(5 citation statements)

References 15 publications

(30 reference statements)

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“…Thus, radiofrequency lesioning is only applied unilaterally and allows the creation of small and localized lesions. Its effectiveness and low cost made this procedure suitable for the surgical treatment of tremors in the past [120][121][122] but due to the high incidence of side effects, it has almost been abandoned…”

Section: Radiofrequency Lesioning Of the Vimmentioning

confidence: 99%

Managing Essential Tremor

Hopfner

Deuschl

2020

Neurotherapeutics

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Essential tremor is one of the most common tremor syndromes. According to the recent tremor classification, tremor as a symptom is defined as an involuntary, rhythmic, oscillatory movement of a body part and is classified along two axes: axis 1-defining syndromes based on the clinical features such as historical features, tremor characteristics, associated signs, and laboratory tests; and axis 2-classifying the etiology (Bhatia et al., Mov Disord 33:75-87, 2018). The management of this condition has two major approaches. The first is to exclude treatable etiologies, as particularly during the onset of this condition the presentation of a variety of etiologies can be with monosymptomatic tremor. Once the few etiologies with causal treatments are excluded, all further treatment is symptomatic. Shared decision-making with enabling the patient to knowledgeably choose treatment options is needed to customize the management. Mild to moderate tremor severity can sometimes be controlled with occupational treatment, speech therapy of psychotherapy, or adaptation of coping strategy. First-line pharmacological treatments include symptomatic treatment with propranolol, primidone, and topiramate. Botulinum toxin is for selected cases. Invasive treatments for essential tremor should be considered for severe tremors. They are generally accepted as the most powerful interventions and provide not only improvement of tremor but also a significant improvement of life quality. The current standard is deep brain stimulation (DBS) of the thalamic and subthalamic region. Focused ultrasound thalamotomy is a new therapy attracting increasing interest. Radiofrequency lesioning is only rarely done if DBS or focused ultrasound is not possible. Radiosurgery is not well established. We present our treatment algorithm.

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Section: Radiofrequency Lesioning Of the Vimmentioning

confidence: 99%

Managing Essential Tremor

Hopfner

Deuschl

2020

Neurotherapeutics

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“…Also, RF ablations are favored in many neurosurgical units because of their relative straightforwardness, short duration of surgery, persistent effect, and low rate of complications [ 27 , 28 ]. Furthermore, RF lesioning was successfully applied after ineffective DBS treatment [ 29 ] and even through DBS electrodes [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…At the same time, other reports showed that thalamotomy may be considered as an option for treating patients who fail to respond to DBS or suffer from adverse effects of stimulation. In some cases, RF lesioning was successfully applied through DBS electrodes [ 19 , 20 ]. Meanwhile, ablative interventions are relatively easier, have a shorter duration, patients do not need regular visits to doctors after treatment, and never lead to DBS withdrawal syndrome, which could develop after the sudden depletion of the implantable generator.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Staged Asymmetric Bilateral Radiofrequency Lesioning for Parkinson’s Disease

Kostiuk

2023

Stereotact Funct Neurosurg

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Introduction: Parkinson’s disease (PD) is one of the most common neurodegenerative progressive disorders. Despite the dominance of neurostimulation technology, stereotactic lesioning operations play a significant role in the treatment of PD. The aim of the study was to evaluate the effectiveness and safety of staged bilateral asymmetric radiofrequency (RF) stereotactic lesioning in a highly selected group of PD patients. Material and Methods: A retrospective review of 418 consecutive patients undergoing stereotactic ablation for advanced PD at our institution revealed 28 patients who underwent staged asymmetric bilateral ablation. In this subset, after initial RF thalamotomy, contralateral pallidotomy was performed in 16 (57.1%) patients (group Vim-GPi), and contralateral lesion of the subthalamic nucleus (STN) was performed in 12 (32.9%) patients (group Vim-STN). The mean duration of disease before the first surgery was 9.9 ± 0.8 years. The mean interval between the two operations was 3.5 ± 0.4 years (range, 1–10 years); in the Vim-GPi group, it was 3.1 ± 0.4 years; and in the Vim-STN group, it was 4.3 ± 0.1 years. After the second operation, the long-term follow-up lasted from 1 to 8 years (mean 4.8 ± 0.5 years). All patients were evaluated 1 year after the second operation. Results: One year after staged bilateral lesioning, the mean tremor score improved from baseline, prior to the first operation, from 19.8 to 3.8 (improvement of 81%), the overall mean rigidity score improved from 11.0 to 3.7 (improvement of 66%), and hypokinesia improved from 14.8 to 8.9 (improvement of 40%). One year after staged bilateral lesioning, the total UPDRS score improved in the Vim-GPi group by 47% in the OFF and 45.9% in the ON states. In the Vim-STN group, the total UPDRS score improved from baseline, prior to the first operation, by 44.8% in the OFF and 51.6% in the ON states. Overall, levodopa dose was reduced by 43.4%. Neurological complications were observed in 4 (14.3%) cases; among them, 1 (3.6%) patient had permanent events related to local ischemia after pallidotomy. Conclusion: Staged asymmetric bilateral stereotactic RF lesioning can be a safe and effective method in highly selected patients with advanced PD, particularly where deep brain stimulation is not available or desirable. Careful identification and selection of patients for ablative surgery allow achieving optimal results in the treatment of PD with bilateral symptoms.

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“…Likewise, a square biphasic pulse delivered through DBS electrodes demonstrated significant improvement in postural tremor, tremor at rest, and action tremor when compared to conventional DBS settings as well as sustained tremor improvement [40,41]. Another interesting application involves administering radiofrequency through previously implanted DBS electrodes, with the aim to provide precise ablation localization and success in ET reduction in a limited set of cases [42][43][44].…”

Section: Nuanced Surgical Methodsmentioning

confidence: 99%

Essential Tremor: Deep Brain Stimulation

Halpern

2020

Stereotactic and Functional Neurosurgery

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Radiofrequency Lesions through Deep Brain Stimulation Electrodes in Movement Disorders: Case Report and Review of the Literature

Cited by 8 publications

References 15 publications

Managing Essential Tremor

Managing Essential Tremor

Stereotactic Staged Asymmetric Bilateral Radiofrequency Lesioning for Parkinson’s Disease

Essential Tremor: Deep Brain Stimulation

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