Bilateral thalamic deep brain stimulation for essential tremor in elderly patients

Klein, Johann; Büntjen, Lars; Jacobi, Gerrit; Galazky, Imke; Panther, Patricia; Zaehle, Tino; Kaufmann, Jörn; Heinze, Hans‐Jochen; Voges, Jürgen; Kupsch, Andreas

doi:10.1007/s00702-017-1741-8

Cited by 13 publications

(22 citation statements)

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“…In one study, there was an improvement of simple reaction time when the DBS was turned on (Heber et al, 2013). In another study, there were improvements in attention and general cognitive functions (Klein et al, 2017). Our study found while the age at surgery had no significant influence, the working memory improved after DBS in ET patients who developed tremors at a younger age.…”

Section: Discussioncontrasting

confidence: 39%

Cognitive Outcomes for Essential Tremor Patients Selected for Thalamic Deep Brain Stimulation Surgery Through Interdisciplinary Evaluations

Jones

Orozco

Bowers

et al. 2020

Front. Hum. Neurosci.

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Objective: Deep brain stimulation (DBS) targeted to the ventral intermediate (VIM) nucleus of the thalamus is effective for motor symptoms in essential tremor (ET), but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients (pre-DBS and 1+ year after DBS).Methods: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. Neuropsychological outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function.Results: We identified 50 ET DBS patients; 29 (58%) males; the mean age of tremor onset was 35.84 (±21.50) years with a median age of 38 years. The mean age at DBS was 68.18 (±10.07) years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment (pre vs. post) and age of tremor onset (<38 vs. >38 years); F(1,30) = 4.47; p = 0.043 for working memory. The post hoc testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment (pre vs. post) and complications vs. no complications subgroups; F(1,45) = 4.34; p = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant.Conclusion: In this large cohort of ET patients with (>30% improvements), DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS.

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Section: Discussioncontrasting

confidence: 39%

Cognitive Outcomes for Essential Tremor Patients Selected for Thalamic Deep Brain Stimulation Surgery Through Interdisciplinary Evaluations

Jones

Orozco

Bowers

et al. 2020

Front. Hum. Neurosci.

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“…After screening titles and abstracts, 479 potentially relevant articles were identified, and the full text was assessed against the inclusion criteria. Finally, 240 articles were chosen to be included in this meta‐analysis …”

Section: Resultsmentioning

confidence: 99%

Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays

Bullard

Hutchison

Lee

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objective A new age of neuromodulation is emerging: one of restorative neuroengineering and neuroprosthetics. As novel device systems move toward regulatory evaluation and clinical trials, a critical need arises for evidence‐based identification of potential sources of hardware‐related complications to assist in clinical trial design and mitigation of potential risk. Materials and Methods The objective of this systematic review is to provide a detailed safety analysis for future intracranial, fully implanted, modular neuroprosthetic systems. To achieve this aim, we conducted an evidence‐based analysis of hardware complications for the most established clinical intracranial modular system, deep brain stimulation (DBS), as well as the most widely used intracranial human experimental system, the silicon‐based (Utah) array. Results Of 2328 publications identified, 240 articles met the inclusion criteria and were reviewed for DBS hardware complications. The most reported adverse events were infection (4.57%), internal pulse generator malfunction (3.25%), hemorrhage (2.86%), lead migration (2.58%), lead fracture (2.56%), skin erosion (2.22%), and extension cable malfunction (1.63%). Of 433 publications identified, 76 articles met the inclusion criteria and were reviewed for Utah array complications. Of 48 human subjects implanted with the Utah array, 18 have chronic implants. Few specific complications are described in the literature; hence, implant duration served as a lower bound for complication‐free operation. The longest reported duration of a person with a Utah array implant is 1975 days (~5.4 years). Conclusions Through systematic review of the clinical and human‐trial literature, our study provides the most comprehensive safety review to date of DBS hardware and human neuroprosthetic research using the Utah array. The evidence‐based analysis serves as an important reference for investigators seeking to identify hardware‐related safety data, a necessity to meet regulatory requirements and to design clinical trials for future intracranial, fully implanted, modular neuroprosthetic systems.

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“…However, these declines were only found with stimulation turned off. 33 Some reported studies have found no cognitive change related to DBS in the thalamic area, 22,27 while others have shown that low-frequency stimulation of the ventrolateral nucleus (VL) has less impact on phonemic and semantic fluency than high-frequency stimulation. 35 In all of the studies we have reviewed, the authors concluded that thalamic stimulation for ET is safe and does not affect higher cognitive processes.…”

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confidence: 99%

Deep brain stimulation in the caudal zona incerta in patients with essential tremor: effects on cognition 1 year after surgery

Philipson

Blomstedt

Hariz

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe ventral intermediate nucleus (VIM) of the thalamus is currently the established target in the use of deep brain stimulation (DBS) to treat essential tremor (ET). In recent years, the caudal zona incerta (cZi), a brain target commonly used during the lesional era, has been revived as the primary target in a number of DBS studies that show evidence of the efficacy of cZi targeting in DBS treatment for controlling the symptoms of ET. The authors sought to obtain comprehensive neuropsychological data and thoroughly investigate the cognitive effects of cZi targeting in patients with ET treated with DBS.METHODSTwenty-six consecutive patients with ET who received DBS with cZi as the target at our department from December 2012 to February 2017 were included in this study. All patients were assessed using a comprehensive neuropsychological test battery covering the major cognitive domains both preoperatively and 12 months postoperatively.RESULTSThe results show no major adverse effects on patient performance on the tests of cognitive function other than a slight decline of semantic verbal fluency.CONCLUSIONSThis study indicates that the cZi is a safe target from a cognitive perspective in the treatment of ET with DBS.

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Bilateral thalamic deep brain stimulation for essential tremor in elderly patients

Cited by 13 publications

References 13 publications

Cognitive Outcomes for Essential Tremor Patients Selected for Thalamic Deep Brain Stimulation Surgery Through Interdisciplinary Evaluations

Cognitive Outcomes for Essential Tremor Patients Selected for Thalamic Deep Brain Stimulation Surgery Through Interdisciplinary Evaluations

Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays

Deep brain stimulation in the caudal zona incerta in patients with essential tremor: effects on cognition 1 year after surgery

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