scholarly journals Long-term Thalamic Deep Brain Stimulation for Essential Tremor: Clinical Outcome and Stimulation Parameters

2016 ◽  
Vol 3 (6) ◽  
pp. 567-572 ◽  
Author(s):  
Pedro M. Rodríguez Cruz ◽  
Antonio Vargas ◽  
Carlos Fernández-Carballal ◽  
Jose Garbizu ◽  
Beatriz De La Casa-Fages ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Stimulation Parameters ◽  
Deep Brain

Long-term results of thalamic deep brain stimulation for essential tremor

2010 ◽  
Vol 112 (6) ◽  
pp. 1271-1276 ◽  
Author(s):  
Kai Zhang ◽  
Sanjay Bhatia ◽  
Michael Y. Oh ◽  
David Cohen ◽  
Cindy Angle ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Visual Analog Scale ◽  
Brain Stimulation ◽  
Analog Scale ◽  
Stimulation Parameters ◽  
Long Term Follow Up ◽  
Deep Brain

Object Deep brain stimulation (DBS) of the ventral intermediate nucleus of the thalamus (VIM) has proven to be efficacious in the treatment of essential tremor (ET). The authors report on long-term follow-up of a series of patients treated at 1 institution by 1 neurosurgeon. Methods Thirty-four patients with ET received unilateral or bilateral VIM DBS. The tremor and handwriting components of the Fahn-Tolosa-Marin clinical tremor rating scale were assessed pre- and postoperatively. Visual analog scale scores for overall patient satisfaction and tremor control were recorded. Stimulation parameters at different intervals after surgery were also recorded. Results The average follow-up period was 56.9 months. The average tremor score improved from 3.27 preoperatively to 0.64 postoperatively (on stimulation; p < 0.001) and the average handwriting score improved from 2.94 to 0.89 (p < 0.001). The average visual analog scale score for overall satisfaction was 8.12 and for tremor control was 1.43. Overall, there was an 80.4% improvement in tremor and 69.7% improvement in handwriting. In 12 patients both tremor and handwriting scores were compared between 57.3 months and 90.7 months after surgery and no significant changes were discovered. Comparison of stimulation parameters at onset and at 1–3, 3–5, 5–7, and > 7 years after surgery showed significant differences, with a gradual increase in stimulation parameters within 5 years after surgery. The overall hardware-related complication rate was 23.5%. Conclusions Deep brain stimulation of the VIM is an efficient and safe treatment for ET. Tremor and handwriting improvements in long-term follow-up are stable. The patients' perception of their outcome is quite good. However, tolerance may develop in some patients requiring changes in stimulation parameters.

scholarly journals Long-Term Effects of Deep Brain Stimulation for Essential Tremor with Subjective and Objective Quantification via Mailed-In Questionnaires

2012 ◽  
Vol 90 (6) ◽  
pp. 394-400 ◽  
Author(s):  
Tatiana H. de Oliveira ◽  
Matthew R. Ginsberg ◽  
Scott Cooper ◽  
Amy Nowacki ◽  
Ali Rezai ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Long Term Effects ◽  
Objective Quantification ◽  
Deep Brain

scholarly journals Clinically Weighted Probabilistic Tractography Mapping of Therapeutic Thalamic Deep Brain Stimulation for Essential Tremor

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Evangelia Tsolaki ◽  
Alon Kashanian ◽  
Nader Pouratian
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Essential Tremor ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Structural Connectivity ◽  
Precentral Gyrus ◽  
Probabilistic Tractography ◽  
Whole Brain ◽  
Deep Brain

Abstract INTRODUCTION Traditional targeting methods rely on indirect targeting with atlas-defined coordinates that induce interpatient anatomical and functional variability. Precise targeting is crucial for successful surgical intervention associated with improved surgical outcomes. Here, we use clinically weighted probabilistic tractography to investigate the connectivity from volume of tissue activated (VTA) to whole brain in order to evaluate the relationship between structural connectivity and clinical outcome of patients that underwent thalamic deep brain stimulation (DBS). METHODS Magnetic resonance imaging and clinical outcomes from 10 essential tremor (ET) patients who were treated by VIM-DBS at the University of California Los Angeles were evaluated. LeadBDS was used for the VTA calculation and FSL was used to evaluate the whole brain probabilistic tractography of VTA. Tractography maps were binarized and weighted based on the percent of clinical improvement using the Fahn-Tolosa-Martin Tremor Rating Score. The resulting clinically weighted maps were non-linearly fused to MNI space and averaged. These population maps provide a voxel-by-voxel map of the average clinical improvement observed when the VTA demonstrates structural connectivity to the whole brain. RESULTS The VTA connectivity to the whole brain was delineated. Superior clinical improvement was associated with connectivity to voxels connecting the thalamus to the precentral gyrus and to the brainstem/cerebellum. Also, the clinical efficacy map showed that patients with higher clinical improvement (>70%) presented stronger structural connectivity to the precentral gyrus and to the caudal projection to the cerebellum. CONCLUSION Stronger connectivity to the precentral gyrus and to brainstem/cerebellum is associated with superior clinical outcome in thalamic DBS for ET. In the future, rather than focusing on connectivity to predetermined targets, these clinically weighted tractography maps can be used with a reverse algorithm to identify the optimal region of the thalamus to provide clinically superior results.

Gait worsening and the microlesion effect following deep brain stimulation for essential tremor

2019 ◽  
Vol 90 (8) ◽  
pp. 913-919 ◽  
Author(s):  
Ryan Roemmich ◽  
Jaimie A Roper ◽  
Robert S Eisinger ◽  
Jackson N Cagle ◽  
Lauren Maine ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Repeated Measures ◽  
Walking Speed ◽  
Stimulation Parameters ◽  
Gait Parameters ◽  
Before And After ◽  
Walking Speeds ◽  
Deep Brain

ObjectiveTo investigate the effects of unilateral thalamic deep brain stimulation (DBS) on walking in persons with medication-refractory essential tremor (ET).MethodsWe performed laboratory-based gait analyses on 24 persons with medication-refractory ET before and after unilateral thalamic DBS implantation. Normal and tandem walking parameters were analysed across sessions (PRE-DBS/DBS OFF/DBS ON) by repeated measures analyses of variance. Pearson’s correlations assessed whether changes in walking after DBS were global (ie, related across gait parameters). Baseline characteristics, lead locations and stimulation parameters were analysed as possible contributors to gait effects.ResultsDBS minimally affected gait at the cohort level. However, 25% of participants experienced clinically meaningful gait worsening. Walking speed decreased by >30% in two participants and by >10% in four others. Decreased walking speed correlated with increased gait variability, indicating global gait worsening in affected participants. The worsening persisted even after the stimulation was turned off. Participants with worse baseline tandem walking performance may be more likely to experience post-DBS gait worsening; the percentage of tandem missteps at baseline was nearly three times higher and tandem walking speeds were approximately 30% slower in participants who experienced gait worsening. However, these differences in tandem walking in persons with gait worsening as compared with those without worsening were not statistically significant. Lead locations and stimulation parameters were similar in participants with and without gait worsening.ConclusionGlobal gait worsening occurred in 25% of participants with unilateral DBS for medication-refractory ET. The effect was present on and off stimulation, likely indicating a microlesion effect.

Bilateral Deep Brain Stimulation for Cervical Dystonia: Long-term Outcome in a Series of 10 Patients

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 957-963 ◽  
Author(s):  
Francesco Cacciola ◽  
Jibril Osman Farah ◽  
Paul R Eldridge ◽  
Patricia Byrne ◽  
Telekath K Varma
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Spasmodic Torticollis ◽  
Long Term Outcome ◽  
Stimulation Parameters ◽  
Deep Brain

Abstract BACKGROUND: Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) was shown to be effective in cervical dystonia refractory to medical treatment in several small short-term and 1 long-term follow-up series. Optimal stimulation parameters and their repercussions on the cost/benefit ratio still need to be established. OBJECTIVE: To report our long-term outcome with bilateral GPi deep brain stimulation in cervical dystonia. METHODS: The Toronto Western Spasmodic Torticollis Rating Scale was evaluated in 10 consecutive patients preoperatively and at last follow-up. The relationship of improvement in postural severity and pain was analyzed and stimulation parameters noted and compared with those in a similar series in the literature. RESULTS: The mean (standard deviation) follow-up was 37.6 (16.9) months. Improvement in the total Toronto Western Spasmodic Torticollis Rating Scale score as evaluated at latest follow-up was 68.1% (95% confidence interval: 51.5-84.6). In 4 patients, there was dissociation between posture severity and pain improvement. Prevalently bipolar stimulation settings and high pulse widths and amplitudes led to excellent results at the expense of battery life. CONCLUSION: Improvement in all 3 subscale scores of the Toronto Western Spasmodic Torticollis Rating Scale with bilateral GPi deep brain stimulation seems to be the rule. Refinement of stimulation parameters might have a significant impact on the cost/benefit ratio of the treatment. The dissociation of improvement in posture severity and pain provides tangible evidence of the complex nature of cervical dystonia and offers interesting insight into the complex functional organization of the GPi.

scholarly journals Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor

Neurology ◽  
2020 ◽  
Vol 94 (10) ◽  
pp. e1073-e1084 ◽  
Author(s):  
Takashi Tsuboi ◽  
Zakia Jabarkheel ◽  
Pamela R. Zeilman ◽  
Matthew J. Barabas ◽  
Kelly D. Foote ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Statistical Significance ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

ObjectiveTo assess longitudinal tremor outcomes with ventral intermediate nucleus deep brain stimulation (VIM DBS) in patients with dystonic tremor (DT) and to compare with DBS outcomes in essential tremor (ET).MethodsWe retrospectively investigated VIM DBS outcomes for 163 patients followed at our center diagnosed with either DT or ET. The Fahn-Tolosa-Marin tremor rating scale (TRS) was used to assess change in tremor and activities of daily living (ADL) at 6 months, 1 year, 2–3 years, 4–5 years, and ≥6 years after surgery.ResultsTwenty-six patients with DT and 97 patients with ET were analyzed. Compared to preoperative baseline, there were significant improvements in TRS motor up to 4–5 years (52.2%; p = 0.032) but this did not reach statistical significance at ≥6 years (46.0%, p = 0.063) in DT, which was comparable to the outcomes in ET. While the improvements in the upper extremity tremor, head tremor, and axial tremor were also comparable between DT and ET throughout the follow-up, the ADL improvements in DT were lost at 2–3 years follow-up.ConclusionOverall, tremor control with VIM DBS in DT and ET was comparable and remained sustained at long term likely related to intervention at the final common node in the pathologic tremor network. However, the long-term ADL improvements in DT were not sustained, possibly due to inadequate control of concomitant dystonia symptoms. These findings from a large cohort of DT indicate that VIM targeting is reasonable if the tremor is considerably more disabling than the dystonic features.Classification of evidenceThis study provides Class IV evidence that VIM DBS improves tremor in patients with DT or ET.

Long-term efficacy of deep brain stimulation for essential tremor

Neurology ◽  
2019 ◽  
Vol 92 (12) ◽  
pp. e1378-e1386 ◽  
Author(s):  
Steffen Paschen ◽  
Julia Forstenpointner ◽  
Jos Becktepe ◽  
Sebastian Heinzel ◽  
Helge Hellriegel ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Rebound Effect ◽  
Short Term ◽  
Term Efficacy ◽  
Secondary Outcomes ◽  
Deep Brain

ObjectiveDeep brain stimulation (DBS) of the ventral intermediate thalamic nucleus (Vim) is established for medically refractory severe essential tremor (ET), but long-term efficacy is controversial.MethodsTwenty patients with ET with DBS had standardized video-documented examinations at baseline, in the stimulation-on condition at short term (13.1 ± 1.9 months since surgery, mean ± SEM), and in the stimulator switched on and off (stim-ON/OFF) at long term; all assessments were done between 32 and 120 months (71.9 ± 6.9 months) after implantation. The primary outcome was the Tremor Rating Scale (TRS) blindly assessed by 2 trained movement disorder neurologists. Secondary outcomes were TRS subscores A, B, and C; Archimedes spiral score; and activities of daily living score. At long-term follow-up, tremor was additionally recorded with accelerometry. The rebound effect after switching the stimulator off was assessed for 1 hour in a subgroup.ResultsTremor severity worsened considerably over time in both in the nonstimulated and stimulated conditions. Vim-DBS improved the TRS in the short term and long term significantly. The spiral score and functional measures showed similar improvements. All changes were highly significant. However, the stimulation effect was negatively correlated with time since surgery (ρ = −0.78, p < 0.001). This was also true for the secondary outcomes. Only one-third of the patients had a rebound effect terminated 60 minutes after the stimulator was switched off. Long-term worsening of the TRS was more profound during stim-ON than in the stim-OFF condition, indicating habituation to stimulation.ConclusionVim-DBS loses efficacy over the long term. Efforts are needed to improve the long-term efficacy of Vim-DBS.Classification of evidenceThis study provides Class IV evidence that for patients with medically refractory severe ET, the efficacy of Vim-DBS severely decreases over 10 years.

Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor

2001 ◽  
Vol 16 (3) ◽  
pp. 464-468 ◽  
Author(s):  
William C. Koller ◽  
Kelly E. Lyons ◽  
Steven B. Wilkinson ◽  
Alexander I. Troster ◽  
Rajesh Pahwa
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Safety And Efficacy ◽  
Deep Brain ◽  
Stimulation Of

Long-term clinical outcome of deep brain stimulation in PKAN syndrome

2017 ◽  
Vol 21 ◽  
pp. e179
Author(s):  
Victoria Gonzalez ◽  
Laura Cif ◽  
Christophe Milesi ◽  
Gilles Cambonie ◽  
Isabelle de Antonio Rubio ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Brain Stimulation ◽  
Deep Brain
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