High‐frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor

Abstract

Pharmacologic treatment for essential tremor and the tremor of Parkinson's disease is often inadequate. Stereotaxic surgery, such as thalamotomy, can effectively reduce tremors. We performed a multicenter trial of unilateral high-frequency stimulation of the ventral intermedius nucleus of the thalamus in 29 patients with essential tremor and 24 patients with Parkinson's disease, using a blinded assessment at 3 months after surgery to compare clinical rating of tremor with stimulation ON with stimulation OFF and baseline and a 1-year follow-up. Six patients were not implanted because of lack of intraoperative tremor suppression (2 patients), hemorrhage (2 patients), withdrawal of consent (1 patient), and persistent microthalamotomy effect (1 patient). A significant reduction in both essential and parkinsonian tremor occurred contralaterally with stimulation. Patients reported a significant reduction in disability. Measures of function were significantly improved in patients with essential tremor. Complications related to surgery in implanted patients were few. Stimulation was commonly associated with transient paresthesias. Other adverse effects were mild and well tolerated. Efficacy was not reduced at 1 year. Chronic high-frequency stimulation is safe and highly effective in ameliorating essential and parkinsonian tremor.

Morphological differences in Parkinson’s disease with and without rest tremor

“…A strong argument in favor of a contribution of the cerebellum and its projections to the thalamus in the pathogenesis of rest tremor comes from experience with stereotactic surgery. The thalamic targets, Vim [5,10,44,46,47] and the cerebello-thalamic projections [11], have proven efficacious in the suppression of rest tremor and Vim was even postulated to a better target than the ventro-oralis posterior nucleus (Vop) receiving pallidal afferents [61]. The fact that Vim receives cerebellar afferents, but none from the basal ganglia [34], implies that rest tremor originates from either a cerebellar generator [61] or an interaction of the basal ganglia-and cerebellothalamo-cortical circuits in the cerebral cortex, where those segregated circuits converge [16].…”

Stimulation of Entorhinal Cortex Promotes Adult Neurogenesis and Facilitates Spatial Memory

“…To date, Ͼ60,000 patients have been implanted with deep brain electrodes (Ponce and Lozano, 2010), and its predominant application has been in the treatment of movement disorders, most commonly Parkinson's disease (Koller et al, 1997;Vidailhet et al, 2005;Deuschl et al, 2006). However, studies have also begun to explore its potential application to a widening array of neurologic and psychiatric conditions, including disorders of mood and thought.…”

Effects of thalamic stimulation frequency on intention and postural tremor

“…Specifically, the kinetic component includes intention tremor, defined as tremor that increases with target-directed movements (Smaga 2003). Many individuals with essential tremor (ET) have noted remarkable reduction of tremor with deep brain stimulation of the ventral intermediate nucleus (VIM) of the thalamus (Benabid et al 1997, Koller et al 1997, Schuurman et al 2000. In our clinical practice, we typically set stimulator frequency at 185 Hz, while adjusting voltage and pulse width to optimize tremor control.…”