scholarly journals Directional Deep Brain Stimulation of the Thalamic Ventral Intermediate Area for Essential Tremor Increases Therapeutic Window

2020 ◽  
Author(s):  
Sabine Bruno ◽  
Petyo Nikolov ◽  
Christian J. Hartmann ◽  
Carlos Trenado ◽  
Philipp J. Slotty ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Therapeutic Window ◽  
Intermediate Area ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Chronic embedded cortico-thalamic closed-loop deep brain stimulation for the treatment of essential tremor

2020 ◽  
Vol 12 (572) ◽  
pp. eaay7680
Author(s):  
Enrico Opri ◽  
Stephanie Cernera ◽  
Rene Molina ◽  
Robert S. Eisinger ◽  
Jackson N. Cagle ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Closed Loop ◽  
Motor Behavior ◽  
Open Loop ◽  
Therapeutic Window ◽  
Patient Specific ◽  
Stimulation Paradigm ◽  
Deep Brain

Deep brain stimulation (DBS) is an approved therapy for the treatment of medically refractory and severe movement disorders. However, most existing neurostimulators can only apply continuous stimulation [open-loop DBS (OL-DBS)], ignoring patient behavior and environmental factors, which consequently leads to an inefficient therapy, thus limiting the therapeutic window. Here, we established the feasibility of a self-adjusting therapeutic DBS [closed-loop DBS (CL-DBS)], fully embedded in a chronic investigational neurostimulator (Activa PC + S), for three patients affected by essential tremor (ET) enrolled in a longitudinal (6 months) within-subject crossover protocol (DBS OFF, OL-DBS, and CL-DBS). Most patients with ET experience involuntary limb tremor during goal-directed movements, but not during rest. Hence, the proposed CL-DBS paradigm explored the efficacy of modulating the stimulation amplitude based on patient-specific motor behavior, suppressing the pathological tremor on-demand based on a cortical electrode detecting upper limb motor activity. Here, we demonstrated how the proposed stimulation paradigm was able to achieve clinical efficacy and tremor suppression comparable with OL-DBS in a range of movements (cup reaching, proximal and distal posture, water pouring, and writing) while having a consistent reduction in energy delivery. The proposed paradigm is an important step toward a behaviorally modulated fully embedded DBS system, capable of delivering stimulation only when needed, and potentially mitigating pitfalls of OL-DBS, such as DBS-induced side effects and premature device replacement.

Efficacy of unilateral deep brain stimulation of the thalamic ventralis intermedius nucleus in a patient with bipolar disorder associated with Klinefelter syndrome and essential tremor

2000 ◽  
Vol 93 (1) ◽  
pp. 127-128 ◽  
Author(s):  
Albert E. Telfeian ◽  
John A. Boockvar ◽  
Tanya Simuni ◽  
Jurg Jaggi ◽  
Brett Skolnick ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Genetic Basis ◽  
Klinefelter Syndrome ◽  
Content Type ◽  
History Of ◽  
Deep Brain ◽  
Stimulation Of

✓ Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) is a safe and effective treatment for essential tremor. Bipolar disorder and essential tremor had each been reported to occur in association with Klinefelter syndrome but the three diseases have been reported to occur together in only one patient. The genetic basis and natural history of these disorders are not completely understood and may be related rather than coincidental. The authors report on a 23-year-old man with Klinefelter syndrome (47,XXY) and bipolar disorder who was treated successfully with unilateral DBS of the thalamic Vim for essential tremor.

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

Deep brain stimulation of the VIM thalamic nucleus modifies several features of essential tremor

Neurology ◽  
2003 ◽  
Vol 61 (7) ◽  
pp. 919-925 ◽  
Author(s):  
D. E. Vaillancourt ◽  
M. M. Sturman ◽  
L. Verhagen Metman ◽  
R. A.E. Bakay ◽  
D. M. Corcos
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Thalamic Nucleus ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Deep brain stimulation of the ventralis intermedius nucleus for the treatment of essential tremor

2017 ◽  
Vol 42 (videosuppl2) ◽  
pp. V3
Author(s):  
Alexander G. Chartrain ◽  
Ahmed J. Awad ◽  
Jonathan J. Rasouli ◽  
Robert J. Rothrock ◽  
Brian H. Kopell
Keyword(s):  
Deep Brain Stimulation ◽  
Physical Examination ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Optimal Trajectory ◽  
Lesion Effect ◽  
Lead Placement ◽  
History Of ◽  
Deep Brain ◽  
Stimulation Of

A 59-year-old woman with a 30-year history of essential tremor refractory to medical therapy underwent staged deep brain stimulation of the ventralis intermedius nucleus of the thalamus (VIM). Left-sided lead placement was performed first. Once in the operating room, microelectrode recording (MER) was performed to confirm the appropriate trajectory and identify the VIM border with the ventralis caudalis nucleus. MER was repeated after repositioning 2 mm anteriorly to reduce the likelihood of stimulation-induced paresthesias. Physical examination prior to permanent lead placement demonstrated micro-lesion effect, suggesting optimal trajectory. After implantation of the permanent lead, physical examination showed excellent results.The video can be found here: https://youtu.be/nn3KRdmRCZ4.

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