Back to Search
Start Over
Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia
- Source :
- Neurology, Vol. 89, No 13 (2017) pp. 1416-1423
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- Objective:To report on the long-term outcomes of deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) in Parkinson disease (PD), essential tremor (ET), and dystonic tremor.Methods:One hundred fifty-nine patients with PD, ET, and dystonia underwent VIM DBS due to refractory tremor at the Grenoble University Hospital. The primary outcome was a change in the tremor scores at 1 year after surgery and at the latest follow-up (21 years). Secondary outcomes included the relationship between tremor score reduction over time and the active contact position. Tremor scores (Unified Parkinson's Disease Rating Scale-III, items 20 and 21; Fahn, Tolosa, Marin Tremor Rating Scale) and the coordinates of the active contacts were recorded.Results:Ninety-eight patients were included. Patients with PD and ET had sustained improvement in tremor with VIM stimulation (mean improvement, 70% and 66% at 1 year; 63% and 48% beyond 10 years, respectively; p < 0.05). There was no significant loss of stimulation benefit over time (p > 0.05). Patients with dystonia exhibited a moderate response at 1-year follow-up (41% tremor improvement, p = 0.027), which was not sustained after 5 years (30% improvement, p = 0.109). The more dorsal active contacts' coordinates in the right lead were related to a better outcome 1 year after surgery (p = 0.029). During the whole follow-up, forty-eight patients (49%) experienced minor side effects, whereas 2 (2.0%) had serious events (brain hemorrhage and infection).Conclusions:VIM DBS is an effective long-term (beyond 10 years) treatment for tremor in PD and ET. Effects on dystonic tremor were modest and transient.Classification of evidence:This provides Class IV evidence. It is an observational study.
- Subjects :
- Adult
Male
0301 basic medicine
Deep brain stimulation
Deep Brain Stimulation
Essential Tremor
Ocular tremor
medicine.medical_treatment
Disease
03 medical and health sciences
0302 clinical medicine
Rating scale
medicine
Humans
Thalamic stimulator
Aged
Retrospective Studies
Dystonia
Ventral Thalamic Nuclei
Essential tremor
business.industry
Parkinson Disease
Retrospective cohort study
Middle Aged
medicine.disease
ddc:616.8
Treatment Outcome
030104 developmental biology
Anesthesia
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
Follow-Up Studies
Subjects
Details
- ISSN :
- 1526632X and 00283878
- Volume :
- 89
- Database :
- OpenAIRE
- Journal :
- Neurology
- Accession number :
- edsair.doi.dedup.....876d7ec9ec446d41409cc54acf2d691d