Deep brain stimulation for vocal tremor: a comprehensive, multidisciplinary methodology

Ho, Allen L.; Erickson‐DiRenzo, Elizabeth; Pendharkar, Arjun V; Sung, C. Kwang; Halpern, Casey H.

doi:10.3171/2015.3.focus1537

Cited by 25 publications

(22 citation statements)

References 49 publications

(60 reference statements)

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“…In this study, we found that the most significant cluster associated with the best control of VT was located in the Vcai nucleus and in the most medial and ventral part of the Vim nucleus of the thalamus. These areas have been somatotopically related with the motor control of the orofacial regions [25, 40]. The Vcai projects to the ventral somatosensory cortex and conveys proprioceptive information from the articulatory apparatus including the oral cavity, lips, jaw, and pharynx.…”

Section: Discussionmentioning

confidence: 99%

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Unilateral Thalamic Deep Brain Stimulation for Voice Tremor

Avecillas-Chasín

Poologaindran

Morrison

et al. 2018

Stereotact Funct Neurosurg

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Background: Voice tremor (VT) is the involuntary and rhythmical phonatory instability of the voice. Recent findings suggest that unilateral deep brain stimulation of the ventral intermediate nucleus (Vim-DBS) can sometimes be effective for VT. In this exploratory analysis, we investigated the effect of Vim-DBS on VT and tested the hypothesis that unilateral thalamic stimulation is effective for patients with VT. Methods: Seven patients with VT and previously implanted bilateral Vim-DBS were enrolled in the study. Each patient was randomized and recorded performing sustained phonation during the following conditions: left thalamic stimulation, right thalamic stimulation, bilateral thalamic stimulation (Bil-ON), and no stimulation (Bil-OFF). Perceptual VT ratings and an acoustic analysis to find the rate of variation of the fundamental frequency measured by the standard deviation of the pitch (f0SD) were performed in a blinded manner. For the purposes of this study, a “dominant” side was defined as one with more than twice as much reduction in VT following Vim-DBS compared to the contralateral side. The Wilcoxon signed-rank test was performed to compare the effect of the dominant side stimulation in the reduction of VT scores and f0SD. The volume of activated tissue (VAT) of the dominant stimulation side was modelled against the degree of improvement in VT to correlate the significant stimulation cluster with thalamic anatomy. Finally, tractography analysis was performed to analyze the connectivity of the significant stimulation cluster. Results: Unilateral stimulation was beneficial in all 7 patients. Five patients clearly had a “dominant” side with either benefit only seen following stimulation of one side or more than twice as much benefit from one side compared to the other. Two patients had similar benefit with unilateral stimulation from either side. The Wilcoxon paired test showed significant differences between unilateral dominant and unilateral nondominant stimulation for VT scores (p = 0.04), between unilateral dominant and Bil-OFF (p = 0.04), and between Bil-ON and unilateral nondominant stimulation (p = 0.04). No significant differences were found between Bil-ON and unilateral dominant condition (p = 0.27), or between Bil-OFF and unilateral nondominant (p = 0.23). The dominant VAT showed that the significant voxels associated with the best VT control were located in the most ventral and medial part of the Vim nucleus and the ventralis caudalis anterior internus nucleus. The connectivity analysis showed significant connectivity with the cortical areas of the speech circuit. Conclusions: Unilateral dominant-side thalamic stimulation and bilateral thalamic stimulation were equally effective in reducing VT. Nondominant unilateral stimulation alone did not significantly improve VT.

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Section: Discussionmentioning

confidence: 99%

“…Bilateral thalamic stimulation has long been recommended for VT [7, 25-30]. Authors have argued that midline or axial tremors require bilateral stimulation because the axial musculature receives bilateral innervation [6, 7, 30].…”

Section: Discussionmentioning

confidence: 99%

Unilateral Thalamic Deep Brain Stimulation for Voice Tremor

Avecillas-Chasín

Poologaindran

Morrison

et al. 2018

Stereotact Funct Neurosurg

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“…The preoperative examination by the speech language pathologist serves to characterize instrumental and acoustic qualities of the vocal tremor, to develop behavioral strategies for patients to reduce phonatory collision forces at the region of identified pathology. These objective measures also establish a baseline from which to measure intra- and postoperative alterations in voice with DBS [6]. …”

Section: Patient Evaluation/assessment Of Evtmentioning

confidence: 99%

“…Symptoms may be exacerbated by involuntary movements of vocal accessory muscles such as chest wall muscles, abdominal muscles, and the diaphragm. Regularity and intensity of acoustic changes are subject to considerable variability between EVT patients [6]. …”

Section: Introductionmentioning

confidence: 99%

Vocal Tremor: Novel Therapeutic Target for Deep Brain Stimulation

Ravikumar

Parker

et al. 2016

Brain Sciences

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Tremulous voice is characteristically associated with essential tremor, and is referred to as essential vocal tremor (EVT). Current estimates suggest that up to 40% of individuals diagnosed with essential tremor also present with EVT, which is associated with an impaired quality of life. Traditional EVT treatments have demonstrated limited success in long-term management of symptoms. However, voice tremor has been noted to decrease in patients receiving deep brain stimulation (DBS) with the targeting of thalamic nuclei. In this study, we describe our multidisciplinary procedure for awake, frameless DBS with optimal stimulation targets as well as acoustic analysis and laryngoscopic assessment to quantify tremor reduction. Finally, we investigate the most recent clinical evidence regarding the procedure.

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“…At my first neurological exam, I learned that ET occurs in nearly 30% of the population, is often benign, and can affect the limbs, head, neck, and voice [1]. Tremor severity can be mild, where a person learns to live with it, and many are never diagnosed.…”

Section: Editorialmentioning

confidence: 99%

Deep Brain Stimulation Salvages a Flourishing Dental Practice: A Dentist with Essential Tremor Recounts his Experience

Giacopuzzi

Lising

Halpern

2016

Cureus

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In recounting his experience with deep brain stimulation (DBS), a practicing dentist challenged with long-standing bilateral essential tremor of the hands shares insights into his diagnosis, treatments, and ultimately successful DBS surgery at Stanford University Medical Center, CA, USA. Now nearly one year after his surgery, his practice continues to flourish and he encourages others in his profession to consider the possibility of DBS as a definitive treatment for tremors of the hand, which may salvage their practice.

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Deep brain stimulation for vocal tremor: a comprehensive, multidisciplinary methodology

Cited by 25 publications

References 49 publications

Unilateral Thalamic Deep Brain Stimulation for Voice Tremor

Unilateral Thalamic Deep Brain Stimulation for Voice Tremor

Vocal Tremor: Novel Therapeutic Target for Deep Brain Stimulation

Deep Brain Stimulation Salvages a Flourishing Dental Practice: A Dentist with Essential Tremor Recounts his Experience

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