Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus

Benabid, Alim Louis; Pollak, Pierre; Hoffmann, D.; Gervason, C L; Hommel, Marc; Perret, J; Rougemont, Jacques; Gao, Dawei

doi:10.1016/0140-6736(91)91175-t

Cited by 1,609 publications

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“…25 Essentially, DBS shows a blocking effect on the stimulated area and mimics the effect of tissue lesioning. 26,27 However, the reversibility of the intervention results in a lower rate of side effects than lesioning with traditional neurosurgical procedures (ie, thermocoagulation). 19 …”

Section: Deep Brain Stimulation and Neurosurgerymentioning

confidence: 99%

“…47 Given that the blocking effect of high-frequency DBS on the stimulated area mimics the effect of tissue lesioning, 26,27 DBS applied to specific areas (the anterior limbs of the internal capsula) would interrupt these hyperactive circuits in the same way as traditional neurosurgical procedures. However, DBS does not cause the irreversible ablation of brain Review Article…”

Section: Deep Brain Stimulation Studies In Obsessivecompulsive Disordermentioning

confidence: 99%

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Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

et al. 2005

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Recent studies on the epidemiology of obsessive-compulsive disorder (OCD) estimate 50 million patients suffer from OCD worldwide, thus making it a global problem. The treatment of OCD has changed substantially over the last 2 decades following the introduction of selective serotonin reuptake inhibitors, which provide symptom improvement in ~60% of patients. However, some patients remain resistant to the standard pharmacologic and behavioral treatments. Although some Needs AssessmentIn the last decade, brain stimulation approaches to neuropsychiatric disorders have been increasingly investigated and are currently defining a "third way" of treatment besides the traditional ones, pharmacologic therapy and psychotherapy. Although some of these techniques are well-established treatments for specific conditions (ie, electroconvulsive therapy for severe depression or deep brain stimulation and transcranial magnetic stimulation in motor disorders) their efficacy in severe or treatment-resistant obsessive-compulsive disorder is still under investigation. Nevertheless, they represent a potential, helpful approach in this highly debilitating condition not only amongst the therapeutic approaches to obsessive-compulsive disorder but also as research means able to elucidate the specific dysfunctional neurocircuits underlying the clinical symptomatology. Learning ObjectivesAt the end of this activity, the participant should be able to:• Differentiate the specific techniques of brain stimulation investigated in the treatment of obsessive-compulsive disorder (OCD) in terms of efficacy, invasiveness, tolerability, and side effects.• Understand the main hypotheses through which these techniques might modify the dysfunctional circuits of OCD.• Understand the potential of these techniques in the field of treatment-resistant OCD, on one hand, and their current investigational state that requires further controlled clinical trials, on the other hand. Target Audience Neurologists and psychiatrists Accreditation StatementMount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide Continuing Medical Education for physicians.Mount Sinai School of Medicine designates this educational activity for a maximum of 3.0 Category 1 credit(s) toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the educational activity.It is the policy of Mount Sinai School of Medicine to ensure fair balance, independence, objectivity and scientific rigor in all its sponsored activities. All faculty participating in sponsored activities are expected to disclose to the audience any real or apparent discussion of unlabeled or investigational use of any commercial product or device not yet approved in the United States.This activity has been peer-reviewed and approved by Eric Hollander, MD, professor of psychiatry, Mount Sinai School of Medicine. Review Date: November 1, 2005. To Receive Credit for This ActivityRead this article, and...

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Section: Deep Brain Stimulation and Neurosurgerymentioning

confidence: 99%

Section: Deep Brain Stimulation Studies In Obsessivecompulsive Disordermentioning

confidence: 99%

Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

et al. 2005

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“…Beginning in the late 1990s, the lesioning strategies were increasingly replaced by high-frequency deep brain stimulation (DBS), a reversible and adjustable form of neuromodulation that was perceived to be less invasive yet equally effective [4]. The use of DBS stems from the seminal publication by Benabid et al [5], reporting that DBS of the thalamus was an effective treatment for tremor, which led to a replacement of thalamotomy. The successful application of DBS to the subthalamic nucleus (STN), following the report of reversal of parkinsonism with STN ablation in the MPTP primate model of parkinsonism [6], led to its widespread use for the treatment of PD and, later, dystonia.…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

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Deep brain stimulation (DBS) is highly effective for both hypo-and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson's disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal gangliathalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.

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“…Thus, while Vim DBS may not significantly impact other cerebellar signs in SCA patients, for those with tremor it can yield marked benefit in functional disability. Historically, stereotactic surgery targeting the Vim, the cerebellar receiving zone of the thalamus, can significantly improve and in many cases abolish tremor in patients with ET 23, 24. This observation has provided compelling evidence in support of a role for the cerebellum in the pathophysiology of ET 25, 26.…”

Section: Discussionmentioning

confidence: 99%

Neuronal activity and outcomes from thalamic surgery for spinocerebellar ataxia

Hashimoto

Muralidharan

Yoshida

et al. 2017

Ann Clin Transl Neurol

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ObjectivesWe investigated the effects of deep brain stimulation (DBS) or lesions of the ventral intermediate nucleus (Vim) of the thalamus for spinocerebellar ataxia (SCA) and examined the pathophysiological role of neuronal activity of the Vim underlying ataxia.MethodsFive patients with SCA with cortical atrophy (ages 60‐69 years; 2 sporadic and three familial SCA) and five patients with essential tremor (ET) (ages 57–71 years) were treated with Vim surgery. Intraoperatively, we recorded neuronal activity from single neurons in the Vim thalamus while patients were at rest and compared the physiological properties of those neurons between patients with SCA and those with ET.ResultsPostsurgery mean scores for the Fahn–Tolosa–Marin Tremor Scale were improved from 78 to 44 in SCA patients and from 54 to 21 in ET patients. Stronger stimulation was necessary to optimize outcomes in SCA as compared to ET patients. We analyzed 68 Vim neurons in SCA and 60 Vim neurons in ET. Mean discharge rates, burst characteristics, and oscillatory activity were similar for both patient groups, however, we observed that the ratio of cells responding to passive manipulation was significantly smaller (P = 0.0001) in SCA (22%) than in ET (71%).InterpretationThalamic surgery led to a significant improvement in tremor in SCA patients. One potential mechanism underlying ataxia in SCA may be disruption of cerebellar sensory feedback, which modulates motor commands in the cerebello‐thalamo‐cortical network.

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Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus

Cited by 1,609 publications

References 9 publications

Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

Neuronal activity and outcomes from thalamic surgery for spinocerebellar ataxia

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