Combined thalamic and pallidal deep brain stimulation for dystonic tremor

Trompette, Caroline; Giordana, Caroline; Leplus, Aurélie; Grabli, David; Hubsch, Cécile; Marsé, Claire; Fontaine, Denys

doi:10.1016/j.parkreldis.2022.08.003

Cited by 8 publications

(15 citation statements)

References 12 publications

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“…Notably, staged implantation of electrodes into a second target is usually described as well tolerated. 11,29,39,41 The side effects of stimulation (such as gait ataxia or dysarthria) may be limiting or intolerable in individual cases, as we also witnessed in one of our cases. Therefore, we conclude that staged implantation of four electrodes in the Vim and the GPi can be considered in patients with severe combined syndromes of tremor and dystonia if needed.…”

Section: Discussionsupporting

confidence: 72%

“…From a neurological point of view, the aim is always to minimize the intervention and to avoid a rescue operation, but this will not always be possible. Notably, staged implantation of electrodes into a second target is usually described as well tolerated 11,29,39,41 . The side effects of stimulation (such as gait ataxia or dysarthria) may be limiting or intolerable in individual cases, as we also witnessed in one of our cases.…”

Section: Discussionsupporting

confidence: 59%

“…If, on the other hand, dystonia is the predominant symptom, GPi-DBS is recommended as the target. 11,[27][28][29] However, our four cases raise the question of whether other factors, such as the anatomical distribution of the tremor, may help to determine the stimulation target. Such a view is supported by a report of a patient with facial and palatal (midline) tremor because of craniofacial dystonia, where normative connectome analysis showed connections of the GPi with the facial area of the motor cortex, whereas the (failed) Vim did not.…”

Section: Discussionmentioning

confidence: 89%

“…When tremor is the predominant symptom and only mild dystonia is present, Vim‐DBS is usually recommended as the primary target. If, on the other hand, dystonia is the predominant symptom, GPi‐DBS is recommended as the target 11,27–29 . However, our four cases raise the question of whether other factors, such as the anatomical distribution of the tremor, may help to determine the stimulation target.…”

Section: Discussionmentioning

confidence: 94%

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The Challenge of Choosing the Right Stimulation Target for Dystonic Tremor—A Series of Instructive Cases

Paschen

Becktepe

Hobert

et al. 2023

Movement Disord Clin Pract

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BackgroundThalamic deep brain stimulation (Th‐DBS) is established for medically refractory tremor syndromes and globus pallidus stimulation (GPi‐DBS) for medically refractory dystonia syndromes. For combined tremor and dystonia syndromes, the best target is unclear.ObjectivesWe present four patients with two different profiles whose clinical course demonstrates that our current analysis of clinical symptomatology is not a sufficient predictor of surgical success.MethodsOutcome parameters were assessed with observer‐blinded video ratings and included the Fahn‐Tolosa‐Marin‐Tremor Rating Scale (FTM‐TRS) and the Unified Dystonia Rating Scale (UDRS).ResultsTwo patients with ‘predominant lateralized action tremor’ of the hands and mild cervical dystonia showed no relevant tremor improvement after GPi‐DBS, but UDRS improved (mean: 45%). Rescue Vim‐DBS electrodes were implanted and both patients benefited significantly with a mean tremor reduction of 51%.Two other patients with ‘axial‐predominant action tremor of the trunk and head’ associated with cervical dystonia underwent bilateral Vim DBS implantation with little effect on tremor (24% reduction in mean FTM‐TRS total score) and no effect on dystonic symptoms. GPi rescue DBS was implanted and showed a significant effect on tremor (63% reduction in mean FTM‐TRS) and dystonia (49% reduction in UDRS).ConclusionsThe diagnosis of dystonic tremor alone is not a sufficient predictor to establish the differential indication of Gpi‐ or Vim‐DBS. Further criteria (e.g., proximal‐distal distribution of tremor/dystonia) are needed to avoid rescue surgery in the future. On the other hand, the course of our patients encourages rescue surgery in such severely disabled patients if the first target fails.This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 94%

See 2 more Smart Citations

The Challenge of Choosing the Right Stimulation Target for Dystonic Tremor—A Series of Instructive Cases

Paschen

Becktepe

Hobert

et al. 2023

Movement Disord Clin Pract

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“…23,24 However, in both modalities of surgical treatment the GPi has the potential to ameliorate dystonia, but VIM studies report a variable response, and is cited as a motivating factor to initially target the GPi with the option of secondary VIM intervention if tremor benefit is insufficient. 27,28 Debate continues over the optimal surgical target for DT; 23,24,27,29 there are favorable reports with PSA and STN DBS, 29 whereas some centers have even adopted an upfront dual VIM-GPi DBS approach in certain cases, 30 but it is our practice, among other centers, to target the VIM over the GPi when tremor is the target symptom. 24,27 In this prospective study, we report the outcomes of the first 66 patients treated with unilateral MRgFUS thalamotomy for medication refractory tremor at our institution.…”

mentioning

confidence: 99%

Outcomes of Focused Ultrasound Thalamotomy in Tremor Syndromes

Peters,

Maamary,

Kyle

et al. 2023

Movement Disorders

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BackgroundThe current literature comparing outcomes after a unilateral magnetic resonance image–guided focused ultrasound (MRgFUS) thalamotomy between tremor syndromes is limited and remains a possible preoperative factor that could help predict the long‐term outcomes.ObjectiveThe aim was to report on the outcomes between different tremor syndromes after a unilateral MRgFUS thalamotomy.MethodsA total of 66 patients underwent a unilateral MRgFUS thalamotomy for tremor between November 2018 and May 2020 at St Vincent's Hospital Sydney. Each patient's tremor syndrome was classified prior to treatment. Clinical assessments, including the hand tremor score (HTS) and Quality of Life in Essential Tremor Questionnaire (QUEST), were performed at baseline and predefined intervals to 36 months.ResultsA total of 63 patients, comprising 30 essential tremor (ET), 24 dystonic tremor (DT), and 9 Parkinson's disease tremor (PDT) patients, returned for at least one follow‐up. In the ET patients, at 24 months there was a 61% improvement in HTS and 50% improvement in QUEST compared to baseline. This is in comparison to PDT patients, where an initial benefit in HTS and QUEST was observed, which waned at each follow‐up, remaining significant only up until 12 months. In the DT patients, similar results were observed to the ET patients: at 24 months there was a 61% improvement in HTS and 43% improvement in QUEST compared to baseline.ConclusionThese results support the use of unilateral MRgFUS thalamotomy for the treatment of DT, which appears to have a similar expected outcome to patients diagnosed with ET. Patients with PDT should be warned that there is a risk of treatment failure. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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The Optimal Targeting for Focused Ultrasound Thalamotomy Differs between Dystonic and Essential Tremor: A 12‐Month Prospective Pilot Study

Golfrè Andreasi,

Braccia,

Levi

et al. 2023

Movement Disord Clin Pract

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BackgroundMagnetic resonance‐guided focused ultrasound (MRgFUS) thalamotomy is increasingly used to treat drug‐resistant essential tremor (ET). Data on MRgFUS thalamotomy in Dystonic Tremor (DT) are anecdotal.ObjectivesTo investigate efficacy, safety, and differences in target coordinates of MRgFUS thalamotomy in DT versus ET.MethodsTen patients with DT and 35 with ET who consecutively underwent MRgFUS thalamotomy were followed for 12 months. Although in both groups the initial surgical planning coordinates corresponded to the Vim, the final target could be modified intraoperatively based on clinical response.ResultsTremor significantly improved in both groups. The thalamic lesion was significantly more anterior in DT than ET. Considering both ET and DT groups, the more anterior the lesion, the lower the odds ratio for adverse events.ConclusionsMRgFUS thalamotomy is safe and effective in DT and ET. Compared to classical Vim coordinates used for ET, more anterior targeting should be considered for DT.This article is protected by copyright. All rights reserved.

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Combined thalamic and pallidal deep brain stimulation for dystonic tremor

Cited by 8 publications

References 12 publications

The Challenge of Choosing the Right Stimulation Target for Dystonic Tremor—A Series of Instructive Cases

The Challenge of Choosing the Right Stimulation Target for Dystonic Tremor—A Series of Instructive Cases

Outcomes of Focused Ultrasound Thalamotomy in Tremor Syndromes

The Optimal Targeting for Focused Ultrasound Thalamotomy Differs between Dystonic and Essential Tremor: A 12‐Month Prospective Pilot Study

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