Double-target DBS for essential tremor: 8-contact lead for cZI and Vim aligned in the same trajectory

Ghilardi, Maria Gabriela dos Santos; Ibarra, Melisa; Alho, Eduardo Joaquim Lopes; Reis, Paul Rodrigo; Contreras, William; Hamani, Clement; Fonoff, Erich Talamoni

doi:10.1212/wnl.0000000000005076

Cited by 25 publications

(25 citation statements)

References 7 publications

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“…An additional, parallel, anteromedial lead could simultaneously traverse the Voa (on proximal contacts) and Zi (on distal contacts), providing access to four distinct targets using two leads ( Figure 3B). In order to engage Vim and Zi or the intermediate PSA target (interface between Zi and Raprl) on the same trajectory ( Figure 3C), the entry point must be moved laterally [62,63]. This approach has been used successfully in many cases of ET [62,63] and Holmes tremor [64], although no large trial has confirmed its formal utility.…”

Section: Directional Leadsmentioning

confidence: 99%

Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

2020

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Tremor is a prevalent symptom associated with multiple conditions, including essential tremor (ET), Parkinson’s disease (PD), multiple sclerosis (MS), stroke and trauma. The surgical management of tremor evolved from stereotactic lesions to deep-brain stimulation (DBS), which allowed safe and reversible interference with specific neural networks. This paper reviews the current literature on DBS for tremor, starting with a detailed discussion of current tremor targets (ventral intermediate nucleus of the thalamus (Vim), prelemniscal radiations (Raprl), caudal zona incerta (Zi), thalamus (Vo) and subthalamic nucleus (STN)) and continuing with a discussion of results obtained when performing DBS in the various aforementioned tremor syndromes. Future directions for DBS research are then briefly discussed.

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Section: Directional Leadsmentioning

confidence: 99%

Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

2020

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“…Because all discussed tremor targets (Vim, Vo, caudal Zi, Raprl, STN) are located in the same area, many authors have suggested lead trajectories engaging multiple targets through different contacts (Figure 3). on the same trajectory ( Figure 3C), the entry point must be moved laterally [56,57]. This approach has been used successfully in many cases of ET [56,57] and Holmes tremor [58], although no large trial has confirmed its formal utility.…”

Section: Combined Targetsmentioning

confidence: 99%

“…on the same trajectory ( Figure 3C), the entry point must be moved laterally [56,57]. This approach has been used successfully in many cases of ET [56,57] and Holmes tremor [58], although no large trial has confirmed its formal utility. For patients with tremor predominant PD, a posterior trajectory targeting both the DRTT and STN [59] or Vim and STN [60] have also been suggested ( Figure 3D).…”

Section: Combined Targetsmentioning

confidence: 99%

Deep Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

Iorio-Morin

Fomenko

Kalia

2020

Preprint

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Tremor is a prevalent symptom associated with multiple conditions, including Essential Tremor (ET), Parkinson’s disease (PD), multiple sclerosis (MS), stroke, and trauma. The surgical management of tremor evolved from stereotactic lesions to deep-brain stimulation (DBS), which allowed safe and reversible interference with specific neural networks. This paper reviews the current literature on DBS for tremor, starting with a detailed discussion of current tremor targets (Vim, Raprl, caudal Zi, Vo and STN) and continuing with a discussion of results obtained when performing DBS in the various aforementioned tremor syndromes. Future directions for DBS research are then briefly discussed.

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“…Moreover, the adverse side effects of PSA-DBS seem to be mild and transient, without enduring side effects or stimulation tolerance (Pahwa et al, 2006;Fytagoridis and Blomstedt, 2010). To date, however, only a few studies have been conducted to assess the safety and effectiveness of PSA-DBS for ET, and even fewer studies have explored the clinical effects of bilateral PSA stimulation (Xie et al, 2012;Ghilardi et al, 2018). Therefore, we retrospectively assessed the clinical outcomes of a series of patients with medically refractory ET who underwent bilateral PSA-DBS.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Posterior Subthalamic Area Deep Brain Stimulation for Essential Tremor: A Case Series

Sun

Huang

Pan

et al. 2020

Front. Hum. Neurosci.

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Background: Deep brain stimulation (DBS) of the posterior subthalamic area (PSA) provides a potentially effective treatment for medication-refractory essential tremor (ET). Objective: To study the clinical benefits and adverse-event profile of bilateral PSA-DBS for refractory ET. Methods: Seven patients with refractory ET underwent bilateral PSA-DBS surgery under general anesthesia between September 2017 and May 2018. Clinical outcome assessments, using the Essential Tremor Rating Scale, were performed at 1-, 6-, and 12-month follow-up, except for the last assessment of one patient who was followed up to 9 months. Analysis was focused on changes in patients' motor symptoms and quality of life following surgery as well as documenting the adverse-event profile associated with the surgical PSA-DBS treatment. Results: After surgery, patients' motor symptoms, including upper limb tremor and head tremor, were improved by 84.2% and their quality of life by 81.25% at 1-month follow-up. The clinical benefits to patients were maintained at 6-month and last follow-up. Adverse side effects included dysarthria (n = 4), balance disorder (n = 2), and paresthesia of the right limb (n = 1). No habituation effects were observed throughout the follow-up. Conclusion: Bilateral PSA-DBS seems to offer an effective and safe alternative treatment for medically intractable ET, warranting further research into its clinical utility, adverse-event profile, and comparative effectiveness.

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Double-target DBS for essential tremor: 8-contact lead for cZI and Vim aligned in the same trajectory

Cited by 25 publications

References 7 publications

Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

Deep Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes

Bilateral Posterior Subthalamic Area Deep Brain Stimulation for Essential Tremor: A Case Series

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