Stimulation of the subthalamic region for essential tremor

Plaha, Puneet; Patel, Nikunj K.; Gill, Steven

doi:10.3171/jns.2004.101.1.0048

Cited by 125 publications

(115 citation statements)

References 38 publications

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“…Correct targeting of the ventro-lateral thalamus has been reported to result in insufficient intraoperative tremor control [6,29,36,37,64], and superior effects on severe intention tremor in ET and MS have been ascribed to DBS in the posterior subthalamic white matter [3,36,45,48,53]. In one of our patients we did not achieve sufficient tremor control until the left electrode which had been inserted properly into the ventro-lateral thalamus was repositioned to be finally placed into the subthalamic area [21].…”

Section: Discussionmentioning

confidence: 96%

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Hamel

Herzog

Kopper

et al. 2007

Acta Neurochir (Wien)

137

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SummaryBackground. The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior.Patients and methods. Eleven patients with disabling intention tremor of different etiology (essential tremor (n ¼ 8), multiple sclerosis (n ¼ 2) and one with, spinocerebellar ataxia) were implanted bilaterally with DBS electrodes targeted to the ventro-lateral thalamus using micro-recording and micro-stimulation. Among five tracks explored in parallel optimal tracks were chosen for permanent electrode implantation. Postoperative tremor suppression elicited by individual electrode contacts was quantified using a lateralised tremor rating scale at least 3 months (in most patients >1 year) after implantation. The position of electrode contacts was determined retrospectively from stereotactic X-ray exams and by correlation of pre-and postoperative MRI.Results. In all patients, DBS suppressed intention tremor markedly. On average, tremor on the left and right side of the body was improved by 68% (AE19; standard deviation) and 73% (AE21), respectively. In most patients, distal electrode contacts located in the subthalamic area proved to be more effective than proximal contacts in the ventro-lateral thalamus. In stereotactic coordinates, the optimal site was located 12.7 mm (AE1.4; mean AE standard deviation) lateral, 7.0 (AE 1.6) mm posterior, and 1.5 (AE 2.0) mm ventral to the mid-commissural point. In general, the best contacts could be selected for permanent stimulation. Nevertheless, in some instances, more proximal contacts had to be chosen because of adverse effects (paraesthesiae, dysarthria, gait ataxia) which were more pronounced with bilateral stimulation resulting in slightly less tremor suppression on the left and right side of body (63 AE 18 and 68 AE 19%, respectively).Conclusion. Direct comparison of different stimulation sites in individual patients revealed that DBS in the subthalamic area is more effective in suppressing pharmacoresistant intention tremor than the ventro-lateral thalamus proper. Anatomical structures possibly involved in tremor suppression include cerebello-thalamic projections, the prelemniscal radiation, and the zona incerta.

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Section: Discussionmentioning

confidence: 96%

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Hamel

Herzog

Kopper

et al. 2007

Acta Neurochir (Wien)

137

View full text Add to dashboard Cite

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“…Although postural tremor may be substantially reduced at a particular stimulation frequency, intention tremor may be less well-controlled by VIM stimulation and be more disabling to the individual in daily life. To date, VIM DBS remains the most commonly performed procedure for the treatment for ET despite newer studies suggesting that DBS in the area of the STN may be more effective at controlling action and intention tremor (Plaha et al 2004, Herzog et al 2007). …”

Section: Discussionmentioning

confidence: 99%

Effects of thalamic stimulation frequency on intention and postural tremor

Earhart

Hong

Tabbal

et al. 2007

Experimental Neurology

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Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus improves essential tremor. Suppression of the amplitude of the postural tremor component with VIM DBS depends on stimulation frequency. The purpose of this study is to determine the effect of DBS frequency on the intention tremor component, i.e. tremor that is enhanced by target-directed movement, and to compare it to the effect of DBS frequency on postural tremor in people with essential tremor. We measured tremor frequency and amplitude during trials of postural holding and voluntary reaching between two targets at 10 different stimulation frequency settings between 0 and 185 Hz. Tremor frequency did not change with changes in stimulation frequency. Amplitude suppression of both intention and postural tremor depended on stimulation frequency. Maximal tremor reduction occurred at approximately 130 Hz for both forms of tremor. However, at optimal frequencies the percent reduction in tremor amplitude relative to the DBS OFF condition was greater for postural than for intention tremor. These results suggest that VIM DBS stimulation frequencies near 130Hz may provide maximal control of intention and postural tremor. Identification of optimal stimulation settings should consider assessment of intention tremor not just postural tremor, as intention tremor may not be as well controlled as postural tremor but may be a better gauge for functional benefit.

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“…29 Another study reported four ET patients with medication-resistant tremor who received bilateral DBS of the subthalamic region. 30 At 12 months after surgery, there were improvements of 81% in overall tremor, 83% in upper extremity tremor, 89% in activities of daily living, 67% in drawing spirals, 77% in pouring water, 58% in line drawing, and 68% in handwriting. In two patients who had severe head tremor at baseline, the tremor resolved at the 12-month follow-up.…”

mentioning

confidence: 99%

Deep Brain Stimulation and Tremor

2008

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Summary: Deep brain stimulation (DBS) has been used to treat various tremor disorders for several decades. Medicationresistant, disabling essential tremor (ET) is the most common tremor disorder treated with DBS. The treatment has been consistently reported to result in significant benefit in upper extremity, as well as head and voice tremor, all of which were improved more dramatically with bilateral procedures. These benefits have been demonstrated to be sustained for up to 7 years. DBS has also been shown to be beneficial for the tremor associated with multiple sclerosis and post-traumatic tremor; however, fewer cases have been reported and the benefit is less consistent, less dramatic, and more transient than that seen with ET. The ventral intermediate nucleus of the thalamus is the most common DBS target for tremor disorders, but more recent studies have demonstrated benefits in tremor from DBS of the subthalamic area, primarily the zona incerta. Surgical complications are relatively uncommon and are generally less frequent than those seen with thalamotomy. Stimulation-related effects are usually mild and resolve with adjustment of stimulation parameters. DBS is thus a relatively safe and effective treatment for tremor disorders, particularly for medication-resistant, disabling ET, but may also have some role in medicationresistant, disabling tremor associated with multiple sclerosis and traumatic head injury.

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Stimulation of the subthalamic region for essential tremor

Cited by 125 publications

References 38 publications

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Effects of thalamic stimulation frequency on intention and postural tremor

Deep Brain Stimulation and Tremor

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