Bilateral thalamic stimulation for the treatment of essential tremor

Pahwa, Rajesh; Lyons, Kelly; Wilkinson, Steven B.; Carpenter, Mary A.; Tröster, Alexander I.; Searl, Jeff; Overman, John; Pickering, Sharon

doi:10.1212/wnl.53.7.1447

Cited by 128 publications

(76 citation statements)

References 15 publications

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“…Average activities of daily living score improved from 12.5 ± 5.3 to 3.5 ± 2.9 after surgery. The magnitude of these changes in TRS scores are in keeping with other published studies that have examined VIM stimulation for essential tremor (Ondo et al 1998, 2001, Pahwa et al 1999. All subjects signed an informed consent prior to participating in this research that was approved by the Human Research Protection Office of Washington University.…”

Section: Subjectssupporting

confidence: 80%

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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Section: Subjectssupporting

confidence: 80%

Effects of thalamic stimulation frequency on intention and postural tremor

Earhart

Hong

Tabbal

et al. 2007

Experimental Neurology

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“…89 Motor scores when the implant was "off" did not differ between baseline evaluations and those performed 6 and 12 months after surgery. However, there were significant improvements in motor scores when the implant was activated at both the 6-and 12-month evaluations (class III).…”

Section: What Is the Efficacy Of Deep Brain Stimulation Of The Thalammentioning

confidence: 80%

“…Two prospective, blinded trials have examined the effects of DBS in patients with ET (n ϭ 23) 88,89 (class III). Although the treatment of patients was not randomized, evaluation was conducted in a blinded, random manner.…”

Section: What Is the Efficacy Of Deep Brain Stimulation Of The Thalammentioning

confidence: 99%

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Practice Parameter: Therapies for essential tremor [RETIRED]

et al. 2005

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Abstract-Background: Essential tremor (ET) is one of the most common tremor disorders in adults and is characterized by kinetic and postural tremor. To develop this practice parameter, the authors reviewed available evidence regarding initiation of pharmacologic and surgical therapies, duration of their effect, their relative benefits and risks, and the strength of evidence supporting their use. Methods: A literature review using MEDLINE, EMBASE, Science Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 1966 and August 2004. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. Results and Conclusions: Propranolol and primidone reduce limb tremor (Level A). Alprazolam, atenolol, gabapentin (monotherapy), sotalol, and topiramate are probably effective in reducing limb tremor (Level B). Limited studies suggest that propranolol reduces head tremor (Level B). Clonazepam, clozapine, nadolol, and nimodipine possibly reduce limb tremor (Level C). Botulinum toxin A may reduce hand tremor but is associated with dose-dependent hand weakness (Level C). Botulinum toxin A may reduce head tremor (Level C) and voice tremor (Level C), but breathiness, hoarseness, and swallowing difficulties may occur in the treatment of voice tremor. Chronic deep brain stimulation (DBS) (Level C) and thalamotomy (Level C) are highly efficacious in reducing tremor. Each procedure carries a small risk of major complications. Some adverse events from DBS may resolve with time or with adjustment of stimulator settings. There is insufficient evidence regarding the surgical treatment of head and voice tremor and the use of gamma knife thalamotomy (Level U). Additional prospective, double-blind, placebo-controlled trials are needed to better determine the efficacy and side effects of pharmacologic and surgical treatments of ET.

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“…Numerous studies report significant improvement with both unilateral and bilateral Vim stimulation, with long-term follow-up showing anywhere from 40% to 80% reduction in tremor severity and corresponding improvement in quality of life [30][31][32][33][34][35][36]. Stimulation-induced adverse effects, including dysarthria, paresthesias, and ataxia can present in upwards of 30% of patients receiving bilateral stimulation [31,35,37,38]. Although these are reversible by changing the stimulation parameters, this may complicate the clinician's ability to program the device in a way that maximizes tremor control.…”

Section: Essential Tremormentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders

Larson

2014

Neurotherapeutics

112

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Deep brain stimulation (DBS) is an implanted electrical device that modulates specific targets in the brain resulting in symptomatic improvement in a particular neurologic disease, most commonly a movement disorder. It is preferred over previously used lesioning procedures due to its reversibility, adjustability, and ability to be used bilaterally with a good safety profile. Risks of DBS include intracranial bleeding, infection, malposition, and hardware issues, such migration, disconnection, or malfunction, but the risk of each of these complications is low-generally ≤ 5% at experienced, large-volume centers. It has been used widely in essential tremor, Parkinson's disease, and dystonia when medical treatment becomes ineffective, intolerable owing to side effects, or causes motor complications. Brain targets implanted include the thalamus (most commonly for essential tremor), subthalamic nucleus (most commonly for Parkinson's disease), and globus pallidus (Parkinson's disease and dystonia), although new targets are currently being explored. Future developments include brain electrodes that can steer current directionally and systems capable of "closed loop" stimulation, with systems that can record and interpret regional brain activity and modify stimulation parameters in a clinically meaningful way. New, image-guided implantation techniques may have advantages over traditional DBS surgery.

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Bilateral thalamic stimulation for the treatment of essential tremor

Abstract: Bilateral thalamic stimulation is effective in reducing tremor and functional disability in ET; however, dysarthria is a possible complication.

Cited by 128 publications

References 15 publications

Effects of thalamic stimulation frequency on intention and postural tremor

Effects of thalamic stimulation frequency on intention and postural tremor

Practice Parameter: Therapies for essential tremor [RETIRED]

Deep Brain Stimulation for Movement Disorders

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