Effect of lead trajectory on the response of essential head tremor to deep brain stimulation

Moscovich, Mariana; Morishita, Takashi; Foote, Kelly D.; Favilla, Christopher G.; Chen, Zhongxing Peng; Okun, Michael S.

doi:10.1016/j.parkreldis.2013.03.015

Cited by 22 publications

(17 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Beyond which brain target should be implanted, there are other important questions facing the field, including whether patients should be implanted uni‐ versus bilaterally and whether and how specific cognitive, mood, and motor profiles should influence surgical decision making. There may be critically underutilized elements of evaluation, including matching the number of targets/electrodes to the symptom profile, optimizing the trajectory of the DBS lead(s), use of novel stimulation parameters for specific symptom profiles, and selection of the type of implantable pulse generator . Many of these factors can be controlled, and we strongly believe that there should be meaningful dialog about their inclusion in the best care of patients…”

Section: The Future For Dbs In Pd: a More Enlightened Approachmentioning

confidence: 99%

Subthalamic Nucleus Versus Globus Pallidus Internus Deep Brain Stimulation: Translating the Rematch Into Clinical Practice

Williams

Foote

Okun

2014

Mov Disord Clin Pract

Self Cite

115

113

View full text Add to dashboard Cite

When formulating a deep brain stimulation (DBS) treatment plan for a patient with Parkinson’s disease (PD), two critical questions should be addressed: 1- Which brain target should be chosen to optimize this patient’s outcome? and 2- Should this patient’s DBS operation be unilateral or bilateral? Over the past two decades, two targets have emerged as leading contenders for PD DBS; the subthalamic nucleus (STN) and the globus pallidus internus (GPi). While the GPi target does have a following, most centers have uniformly employed bilateral STN DBS for all Parkinson’s disease cases (Figure 1). This bilateral STN “one-size-fits-all” approach was challenged by an editorial entitled “STN vs. GPi: The Rematch,” which appeared in the Archives of Neurology in 2005. Since 2005, a series of well designed clinical trials and follow-up studies have addressed the question as to whether a more tailored approach to DBS therapy might improve overall outcomes. Such a tailored approach would include the options of targeting the GPi, or choosing a unilateral operation. The results of the STN vs. GPi ‘rematch’ studies support the conclusion that bilateral STN DBS may not be the best option for every Parkinson’s disease surgical patient. Off period motor symptoms and tremor improve in both targets, and with either unilateral or bilateral stimulation. Advantages of the STN target include more medication reduction, less frequent battery changes, and a more favorable economic profile. Advantages of GPi include more robust dyskinesia suppression, easier programming, and greater flexibility in adjusting medications. In cases where unilateral stimulation is anticipated, the data favor GPi DBS. This review summarizes the accumulated evidence regarding the use of bilateral vs. unilateral DBS and the selection of STN vs. GPi DBS, including definite and possible advantages of different targets and approaches. Based on this evidence, a more patient-tailored, symptom specific approach will be proposed to optimize outcomes of PD DBS therapy. Finally, the importance of an interdisciplinary care team for screening and effective management of DBS patients will be reaffirmed. Interdisciplinary teams can facilitate the proposed patient-specific DBS treatment planning and provide a more thorough analysis of the risk-benefit ratio for each patient.

show abstract

Section: The Future For Dbs In Pd: a More Enlightened Approachmentioning

confidence: 99%

Subthalamic Nucleus Versus Globus Pallidus Internus Deep Brain Stimulation: Translating the Rematch Into Clinical Practice

Williams

Foote

Okun

2014

Mov Disord Clin Pract

Self Cite

115

113

View full text Add to dashboard Cite

show abstract

“…Currently, clinicians are utilizing methods to reduce side effects, particularly mood and cognitive alterations, through the optimization of lead placement within the target (59). Future improvements may include customized modification of the electrode trajectory (60) and placement along with clinical stimulation parameter settings using a patient-specific model and atlas (PSA) (61)(62)(63). The use of temporally nonregular stimulation parameters may also allow for further honing of the therapy in an effort to increase battery life and to improve network delivery (64).…”

Section: Neuropsychiatric Disease and Dbs Targetsmentioning

confidence: 99%

Deep brain stimulation (DBS) at the interface of neurology and psychiatry

Williams¹,

Okun²

2013

J. Clin. Invest.

Self Cite

106

View full text Add to dashboard Cite

“…A common reason for bilateral Vim DBS is the need to treat midline tremor. A recent preliminary study found that a more vertical angle of the DBS lead trajectory is associated with improved head tremor suppression even after unilateral procedures . In addition, bilateral procedures effectively eliminate the need for tremor‐suppressing medications, whereas unilateral stimulation is not as effective in reducing medication usage because of the worsening of tremor in the nontreated hemibody.…”

Section: Treating Tremormentioning

confidence: 99%

Therapeutic advances in tremor

Fasano

Deuschl

2015

Movement Disorders

View full text Add to dashboard Cite

Although tremor is a highly prevalent movement disorder, progress in this field is limited because of the poor understanding of many of the underlying conditions. This review summarizes recent treatment attempts since 2013. For essential tremor, recent innovations are phase I or II studies of Octanol, several clinically relevant refinements for deep brain stimulation, and the development of the new magnetic resonance imaging guided focused ultrasound technique. Further new invasive and noninvasive electrical and magnetic stimulation techniques have been tested for essential tremor and parkinsonian tremor. For multiple sclerosis tremor, some open-label observations have shown positive results (natalizumab, dalfampridine, levetiracetam), whereas controlled trials using cannabinoids have been negative. Functional tremor has shown a positive response to retrainment. Neuroprosthetic devices have been tested in a variety of tremor conditions. Several promising medical and surgical treatment trials are underway and will be completed shortly.

show abstract

Effect of lead trajectory on the response of essential head tremor to deep brain stimulation

Cited by 22 publications

References 33 publications

Subthalamic Nucleus Versus Globus Pallidus Internus Deep Brain Stimulation: Translating the Rematch Into Clinical Practice

Subthalamic Nucleus Versus Globus Pallidus Internus Deep Brain Stimulation: Translating the Rematch Into Clinical Practice

Deep brain stimulation (DBS) at the interface of neurology and psychiatry

Therapeutic advances in tremor

Contact Info

Product

Resources

About