Deep brain stimulation for trauma: Patient selection and evaluation

Abstract

The selection of patients with movement disorders for deep brain stimulation is becoming a common neurological and neurosurgical task. Deep brain stimulation is suitable for different forms of tremor, which can often not be treated with medication. This suitability applies for essential tremor, monosymptomatic tremor at rest, cerebellar or multiple sclerosis tremor, Holmes' tremor, primary writing tremor or tremor in neuropathies. The appropriate selection of patients is critical for the outcome of surgical relief of tremors. Considering the risks of any stereotactic intervention, the following must apply: (1) motor symptoms lead to a relevant disability in activities of daily living, despite optimal medical treatment; (2) biological age of the patient; (3) neurosurgical contraindications; (4) the patient is neither demented nor severely depressed. If these conditions are fulfilled, the individual chances of improvement of the target symptoms need to be checked, based on the following guidelines: (1) the kind of tremor, (2) the natural course of the tremor, (3) the chances for medical treatment in a particular patient, (4) the outcome of surgery in a specific condition, (5) the individual risks for a patient to suffer from complications. The outcome of surgery for tremor depends on the clinical type and distribution. Distal limb tremors are easier to treat than proximal limb tremors. Intention tremor is more difficult to treat than rest or postural tremor. The indication for surgical treatment depends on the analysis of the individual risk-benefit ratio, which also has to take into account the patients' social, professional, and familial background. The patient needs to be well informed about his individual risk-benefit ratio and of alternative treatments, before undergoing stereotactic surgery.

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

“…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).…”

Deep Brain Stimulation to Reward Circuitry Alleviates Anhedonia in Refractory Major Depression

“…Target-point and trajectory were defined using stereotaxic 3 Tesla MR imaging. DBS treatment was applied with permanent pulse-train stimulation (square-wave impulses of 90 ms pulse width, 145 Hz and amplitudes of 4 V, electrodes negative against case), those stimulation parameters were chosen because of the extensive experience with neurostimulation for neurological disorders (Deuschl and Bain, 2002;Deuschl et al, 2006). …”

Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions

“…In selected cases DBS and thermocoagulation may offer an alternative therapeutic strategy. 1,8,15,16,21,23,27 Kim, et al, 15 reported on a 26-year-old man in whom unilateral Vim thalamotomy almost completely abolished Holmes tremor that had been caused by a midbrain tumor. Two additional case reports of patients with a midbrain cavernous angioma 16,23 document good to excellent clinical improvements in Holmes tremor following thalamic Vim stimulation.…”