A Comparison of Continuous Thalamic Stimulation and Thalamotomy for Suppression of Severe Tremor

Schuurman, P. Richard; Bosch, Dirk; Bossuyt, PM; Bonsel, G.J.; Someren, Eus J.W. Van; Bie, Rob M.A. de; Merkus, Maruschka P.; Speelman, J. D.

doi:10.1056/nejm200002173420703

Cited by 936 publications

(579 citation statements)

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“…Recently, this technique was approved by the Food and Drug Administration for the treatment of intractable motor disorders (tremor [20][21][22] and Parkinson's disease 23 ). The stimulating leads are connected via an extension wire to pulse generators typically placed in the chest (Figure).…”

Section: Deep Brain Stimulation and Neurosurgerymentioning

confidence: 99%

Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

et al. 2005

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Recent studies on the epidemiology of obsessive-compulsive disorder (OCD) estimate 50 million patients suffer from OCD worldwide, thus making it a global problem. The treatment of OCD has changed substantially over the last 2 decades following the introduction of selective serotonin reuptake inhibitors, which provide symptom improvement in ~60% of patients. However, some patients remain resistant to the standard pharmacologic and behavioral treatments. Although some Needs AssessmentIn the last decade, brain stimulation approaches to neuropsychiatric disorders have been increasingly investigated and are currently defining a "third way" of treatment besides the traditional ones, pharmacologic therapy and psychotherapy. Although some of these techniques are well-established treatments for specific conditions (ie, electroconvulsive therapy for severe depression or deep brain stimulation and transcranial magnetic stimulation in motor disorders) their efficacy in severe or treatment-resistant obsessive-compulsive disorder is still under investigation. Nevertheless, they represent a potential, helpful approach in this highly debilitating condition not only amongst the therapeutic approaches to obsessive-compulsive disorder but also as research means able to elucidate the specific dysfunctional neurocircuits underlying the clinical symptomatology. Learning ObjectivesAt the end of this activity, the participant should be able to:• Differentiate the specific techniques of brain stimulation investigated in the treatment of obsessive-compulsive disorder (OCD) in terms of efficacy, invasiveness, tolerability, and side effects.• Understand the main hypotheses through which these techniques might modify the dysfunctional circuits of OCD.• Understand the potential of these techniques in the field of treatment-resistant OCD, on one hand, and their current investigational state that requires further controlled clinical trials, on the other hand. Target Audience Neurologists and psychiatrists Accreditation StatementMount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide Continuing Medical Education for physicians.Mount Sinai School of Medicine designates this educational activity for a maximum of 3.0 Category 1 credit(s) toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the educational activity.It is the policy of Mount Sinai School of Medicine to ensure fair balance, independence, objectivity and scientific rigor in all its sponsored activities. All faculty participating in sponsored activities are expected to disclose to the audience any real or apparent discussion of unlabeled or investigational use of any commercial product or device not yet approved in the United States.This activity has been peer-reviewed and approved by Eric Hollander, MD, professor of psychiatry, Mount Sinai School of Medicine. Review Date: November 1, 2005. To Receive Credit for This ActivityRead this article, and...

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Section: Deep Brain Stimulation and Neurosurgerymentioning

confidence: 99%

Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

et al. 2005

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“…Specifically, the kinetic component includes intention tremor, defined as tremor that increases with target-directed movements (Smaga 2003). Many individuals with essential tremor (ET) have noted remarkable reduction of tremor with deep brain stimulation of the ventral intermediate nucleus (VIM) of the thalamus (Benabid et al 1997, Koller et al 1997, Schuurman et al 2000. In our clinical practice, we typically set stimulator frequency at 185 Hz, while adjusting voltage and pulse width to optimize tremor control.…”

Section: Introductionmentioning

confidence: 99%

Effects of thalamic stimulation frequency on intention and postural tremor

Earhart

Hong

Tabbal

et al. 2007

Experimental Neurology

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Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus improves essential tremor. Suppression of the amplitude of the postural tremor component with VIM DBS depends on stimulation frequency. The purpose of this study is to determine the effect of DBS frequency on the intention tremor component, i.e. tremor that is enhanced by target-directed movement, and to compare it to the effect of DBS frequency on postural tremor in people with essential tremor. We measured tremor frequency and amplitude during trials of postural holding and voluntary reaching between two targets at 10 different stimulation frequency settings between 0 and 185 Hz. Tremor frequency did not change with changes in stimulation frequency. Amplitude suppression of both intention and postural tremor depended on stimulation frequency. Maximal tremor reduction occurred at approximately 130 Hz for both forms of tremor. However, at optimal frequencies the percent reduction in tremor amplitude relative to the DBS OFF condition was greater for postural than for intention tremor. These results suggest that VIM DBS stimulation frequencies near 130Hz may provide maximal control of intention and postural tremor. Identification of optimal stimulation settings should consider assessment of intention tremor not just postural tremor, as intention tremor may not be as well controlled as postural tremor but may be a better gauge for functional benefit.

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“…However, some speech impairment might be accepted by patients as a compromise for a better tremor control. 24,25 Ventroposterolateral pallidotomy, 26 dorsal subthalamotomy, 27 and stimulation of both targets 28,29 have been proposed more recently in parkinsonian patients to improve not only tremor, but also akinesia. If akinesia is improved, then parkinsonian dysarthria might also be expected to improve.…”

Section: Abstract: Levodopa (L-dopa) and Subthalamic Nucleus (Stn) Stmentioning

confidence: 99%

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

et al. 2005

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Levodopa (L‐dopa) and subthalamic nucleus (STN) stimulation treatments have been associated with both improvement and exacerbation of dysarthria in Parkinson's disease (PD). We report four cases illustrating variant responses of dysarthria to dopaminergic and STN stimulation therapies. Patients' motor disability and dysarthria were perceptually rated by the Unified Parkinson's Disease Rating Scale (UPDRS) in four conditions according to medication and STN stimulation. Dedicated software packages allowed acquisition and analysis of acoustic recordings. Case 1, who had a severe off period aphonia, experienced improvement of speech induced by both levodopa and STN stimulation. In Case 2, both treatments worsened speech due to the appearance of dyskinesias. Case 3 had a dysarthria exacerbation induced by STN stimulation with parameters above optimal levels, interpreted as current diffusion from the STN to corticobulbar fibers. In Case 4, dysarthria exacerbation occurred with stimulation at an electrode contact located caudally to the target, also arguing for current diffusion as a potential mechanism of speech worsening. The presented cases demonstrated variant effects in relation to L‐dopa and STN stimulation on speech. It seems that motor speech subcomponents can be improved like other limb motor aspect, but that complex coordination of all speech anatomical substrates is not responsive to STN stimulation. These hypotheses may be helpful for better understanding and management of STN stimulation effects on motor speech and skeleton–motor subsystems. © 2005 Movement Disorder Society

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A Comparison of Continuous Thalamic Stimulation and Thalamotomy for Suppression of Severe Tremor

Cited by 936 publications

References 40 publications

Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

Effects of thalamic stimulation frequency on intention and postural tremor

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

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