Electrophysiological evaluation of thalamic DBS for orthostatic tremor

Magariños-Ascone, C; Ruiz, Fidel Martínez; Millán, Álvaro San; Montes, Elena; Regidor, Ignacio; Pedro, M; Figueiras-Méndez, R

doi:10.1002/mds.23333

Cited by 30 publications

(34 citation statements)

References 4 publications

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“…Including these patients there are now 9 published cases of bilateral Vim DBS successfully treating OT [5,6,7,8,9,10]. Only 1 case is published without sustained improvement [5].…”

Section: Discussionmentioning

confidence: 99%

“…Only 1 case is published without sustained improvement [5]. The degree of success after some surgeries is difficult to judge as these manuscripts provide only subjective outcomes [6,8,9,11]. A standardized, objective, patient-centered outcome measure such as standing time is easily performed and has been used in some reports (including ours) [5,7,10]; however, it has not been validated given the rarity of this condition.…”

Section: Discussionmentioning

confidence: 99%

“…Only 8 cases of Vim DBS for OT are published in the literature [5,6,7,8,9,10,11], 7 with sustained symptomatic benefit. Most reports are limited due to a lack of clear outcome measures [6,8,9,11], poor patient characterization [9], or information about the active contact or lead tip location [6,7,8,9,10] (table 1). We present 2 additional patients with OT who experienced meaningful symptomatic improvement after Vim DBS.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral Ventral Intermediate Nucleus Thalamic Deep Brain Stimulation in Orthostatic Tremor

Coleman

Starr²,

Katz³

et al. 2016

Stereotact Funct Neurosurg

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Background: Orthostatic tremor (OT) is characterized by high-frequency leg tremor when standing still, resulting in a sense of imbalance, with limited treatment options. Ventral intermediate (Vim) nucleus thalamic deep brain stimulation (DBS) has been reported as beneficial in a few cases. Objective: To report clinical outcomes, lead locations, and stimulation parameters in 2 patients with severe medication-refractory OT treated with Vim DBS. Methods: The patients underwent surface electromyography (EMG) to confirm the OT diagnosis. Outcomes were measured as change in tolerated standing time at the last follow-up. Lead locations were quantified using postoperative MRI. Results: Vim DBS was well tolerated and resulted in improvement in standing time (patient 1: 50 s at baseline to 15 min 16 months after surgery; patient 2: 34 s at baseline to 4.2 min 7 months after surgery). Postoperative surface EMG for patient 1 demonstrated a delayed onset of tremor, lower-amplitude tremor, and periods of quiescence, but an unchanged tremor frequency. Conclusion: These cases provide further support for Vim DBS to improve standing time in severe medication-refractory OT. The location of the effective thalamic target for OT does not differ from the effective target for essential tremor.

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“…Including these patients there are now 9 published cases of bilateral Vim DBS successfully treating OT [5,6,7,8,9,10]. Only 1 case is published without sustained improvement [5].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bilateral Ventral Intermediate Nucleus Thalamic Deep Brain Stimulation in Orthostatic Tremor

Coleman

Starr²,

Katz³

et al. 2016

Stereotact Funct Neurosurg

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“…DBS of the Vim is an established therapeutic option for the treatment of tremor of central nervous system origin (essential tremor, posttraumatic tremor, or multiple sclerosis-related tremor) [14,15,16,17], and in recent years there have been reports of efficacy for the procedure even in tremors not traditionally candidates for surgery [13]. Regardless of the actual tremor physiopathology, success of the surgical treatment is expected when there is a central nervous system origin of the tremor.…”

Section: Discussionmentioning

confidence: 99%

“…Then, electrical activity was recorded until 2-3 mm below the Vim in steps of 50-100 µm. Vim firings were recognized by their neurophysiological characteristics [13]. The final location of the implanted electrode was determined by the firing activity of the Vim cells, the activity response to movement, and the improvement in the tremor during stimulation with the recording electrode (0.1/200 µA, 100 µs, 130 Hz).…”

Section: Casesmentioning

confidence: 99%

Long-Term Effective Thalamic Deep Brain Stimulation for Neuropathic Tremor in Two Patients with Charcot-Marie-Tooth Disease

Cabañés-Martínez

Pedro²,

Beorlegui³

et al. 2017

Stereotact Funct Neurosurg

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Background: It has been described that many Charcot-Marie-Tooth syndrome type 2 patients are affected by a very disabling type of tremor syndrome, the pathophysiology of which remains unclear. Deep brain stimulation (DBS) has been successfully applied to treat most types of tremors by implanting electrodes in the ventral intermediate nucleus of the thalamus (Vim). Methods: We used DBS applied to the Vim in 2 patients with severe axonal inherited polyneuropathies who developed a disabling tremor. Results: Both patients responded positively to stimulation, with a marked reduction of the tremor and with an improvement of their quality of life. Conclusion: We report 2 cases of tremor associated with a hereditary neuropathy with a good response to DBS.

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Thalamic‐Caudal Zona Incerta Deep Brain Stimulation for Refractory Orthostatic Tremor: A Report of 3 Cases

Georgiev

Avilés-Olmos

Peters

et al. 2016

Movement Disord Clin Pract

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Orthostatic tremor (OT) is a rare, disabling movement disorder characterized by the development of a high-frequency tremor of the lower limbs and feelings of unsteadiness upon standing, which compel the patient to sit down or walk. Medical therapy is often unsatisfactory. Previous reports suggest that deep brain stimulation of the ventral intermediate nucleus of the thalamus may improve clinical outcomes. The authors report 3 patients who had intractable orthostatic tremor treated with bilateral deep brain stimulation of the ventral intermediate nucleus of the thalamus-caudal zona incerta, resulting in improved and sustained clinical improvements in symptoms, although there were no apparent changes in the underlying tremor frequency or onset.First reported in 1970 by Pazzaglia and colleagues, the term orthostatic tremor (OT) was coined by Heilman in 1984 to describe a tremor of the legs or trunk induced by standing, causing feelings of unsteadiness or shakiness, compelling patients to sit or walk. 1,2 Although falls are uncommon, symptoms invariably progress and can cause considerable distress to quality of life. Development of a concurrent upper-limb tremor is not uncommon, and 11% to 15% of patients have additional neurological features, such as parkinsonism or ataxia, termed "OTplus." 3,4 Electromyography (EMG) reveals a characteristic, high-frequency tremor of 13 to 18 Hz in the lower limbs that demonstrates high intermuscular coherence, which can be used to differentiate it from other types of tremor. Clinical examination may reveal a barely detectable ripple of leg muscles, although auscultation with a stethoscope over the thigh, quadriceps, and hamstrings can reveal a repetitive thumping soundthe so-called helicopter sign. 5 Although anecdotal evidence suggests that treatment with clonazepam, gabapentin, and other antitremor drugs may offer some benefit to patients, the results are often unsatisfactory. 3,6 The pathophysiology of OT is unclear; OT is generally thought to originate from a central oscillator, but involvement of the spinal cord has also been postulated, and surgical treatment for refractory OT has been reported in a small number of patients. Deep brain stimulation (DBS) of the ventral intermediate (ViM) nucleus of the thalamus has been reported in 8 patients, and spinal cord dorsal column stimulation also has been reported in 3 patients (Table 1).In this report, we describe the clinical and electrophysiological effects of high-frequency DBS of the ViM nucleus of the thalamus-caudal zona incerta in 3 patients suffering from refractory OT. CasesPatient 1 (a 46-year-old woman) complained of a 20-year history of unsteadiness during standing that was relieved on sitting, leaning, or walking. The latency between standing and the onset of unsteadiness remained at 30 seconds since onset, although, in the year preceding assessment, she also developed an alcohol-responsive kinetic tremor of the right hand and sub-1

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Electrophysiological evaluation of thalamic DBS for orthostatic tremor

Cited by 30 publications

References 4 publications

Bilateral Ventral Intermediate Nucleus Thalamic Deep Brain Stimulation in Orthostatic Tremor

Bilateral Ventral Intermediate Nucleus Thalamic Deep Brain Stimulation in Orthostatic Tremor

Long-Term Effective Thalamic Deep Brain Stimulation for Neuropathic Tremor in Two Patients with Charcot-Marie-Tooth Disease

Thalamic‐Caudal Zona Incerta Deep Brain Stimulation for Refractory Orthostatic Tremor: A Report of 3 Cases

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