Chronic Electrical Stimulation of the VL-VPL Complex and of the Pallidum in the Treatment of Movement Disorders: Personal Experience since 1982

Siegfried, J.

doi:10.1159/000098599

Cited by 127 publications

(56 citation statements)

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“…However, deeper electrode insertion and even more ventral (postero-medial) stimulation are more likely to be limited by adverse events. In contrast to the ventro-lateral thalamus, targeting of the subthalamic area bears a higher risk of dysarthria, paraesthesiae, and gait ataxia which is pronounced with bilateral stimulation (possibly mimicking a bilateral subthalamotomy) [56,68]. In some instances, side effects required permanent stimulation with a contact proximal to the optimal contact which, however, had only a slight effect on postoperative tremor improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Deep brain stimulation (DBS) within the ventro-lateral thalamus is an effective treatment for tremor, the most common movement disorder, irrespective of aetiology [2,4,7,9,10,23,37,43,55,56,60,65]. The ventrolateral thalamus has been introduced by Hassler [26,27] and later adopted by numerous stereotactic centers for the treatment of tremor and other hyperkinetic disorders [1, 8, 13, 22, 32, 34, 49-51, 60, 68].…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, modern imaging modalities were not available at the time most operations were performed, thus, the exact site of lesioning performed in thousands of patients has to remain obscure. Nowadays, DBS has taken the place of lesioning [7,55,56,59,60] making bilateral operations feasible, and the selection of active contacts allows for spatial adjustments after the operation. In this study the actual position of implanted electrodes was determined retrospectively by stereotactic means and correlated with clinical efficacy in patients suffering from disabling bilateral intention tremor.…”

Section: Introductionmentioning

confidence: 99%

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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)

138

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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: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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)

138

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“…DBS offers important advantages over the immutable effects of ablative procedures, including the reversibility of the surgical outcome and the ability to adjust stimulation parameters postoperatively to optimize therapeutic benefit for the patient while minimizing adverse side effects. 7,8 Thousands of DBS implants are now performed each year for a growing number of movement disorders. [9][10][11] Nonetheless, despite the clinical successes of DBS, we still lack a fully formulated theory for how DBS works.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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Summary:Chronic electrical stimulation of the brain, known as deep brain stimulation (DBS), has become a preferred surgical treatment for medication-refractory movement disorders. Despite its remarkable clinical success, the therapeutic mechanisms of DBS are still not completely understood, limiting opportunities to improve treatment efficacy and simplify selection of stimulation parameters. This review addresses three questions essential to understanding the mechanisms of DBS. 1) How does DBS affect neuronal tissue in the vicinity of the active electrode or electrodes? 2) How do these changes translate into therapeutic benefit on motor symptoms? 3) How do these effects depend on the particular site of stimulation? Early hypotheses proposed that stimulation inhibited neuronal activity at the site of stimulation, mimicking the outcome of ablative surgeries. Recent studies have challenged that view, suggesting that although somatic activity near the DBS electrode may exhibit substantial inhibition or complex modulation patterns, the output from the stimulated nucleus follows the DBS pulse train by direct axonal excitation. The intrinsic activity is thus replaced by high-frequency activity that is time-locked to the stimulus and more regular in pattern. These changes in firing pattern are thought to prevent transmission of pathologic bursting and oscillatory activity, resulting in the reduction of disease symptoms through compensatory processing of sensorimotor information. Although promising, this theory does not entirely explain why DBS improves motor symptoms at different latencies. Understanding these processes on a physiological level will be critically important if we are to reach the full potential of this powerful tool.

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“…14, Of the 38 articles identified for DBS of the thalamus, 16 articles met criteria. [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] The review of DBS of the globus pallidus consisted of all 10 articles identified, [56][57][58][59][60][61][62][63][64][65] and DBS of the subthalamic nucleus was based on all 6 articles identified. 62,[66][67][68][69][70] There were 52 articles for adrenal medullary transplantation, but the review includes only the 9 that met criteria.…”

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confidence: 99%

Evaluation of surgery for Parkinson’s disease

Hallett¹,

Litvan²

1999

Neurology

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the Task Force on Surgery for Parkinson's Disease* PD is a common disorder affecting on average 100 per 100,000 population. Despite the large number of medications available for the treatment of early and moderately advanced PD, options specifically designed for the patient with advanced disease are limited. Surgery for PD dates from 1939-1940, when Bucy and Case 1 and Klemme 2 excised parts of the cerebral cortex to treat tremor and dystonia, but this type of surgery produced hemiparesis. Surgical basal ganglia lesions were introduced a few years later by Meyers, 3,4 who found that pallidotomy produced significant relief of tremor, rigidity, and dyskinesias, but with considerable mortality. Stereotaxic techniques to coagulate the globus pallidus in PD were introduced in the 1950s by Spiegel and Wycis, 5,6 and Cooper was an early advocate of pallidal surgery.7 Based on the anatomic connections between the pallidum and the thalamus, Hassler introduced the concept of surgery on the ventrolateral nucleus of the thalamus. 8,9Microelectrode recording allowed Narabayashi 10,11 to find that lesioning the ventral intermediate (Vim) nucleus of the thalamus was the most specific target to control the tremor in PD. Neurosurgery reached its peak in the 1960s, but declined after the introduction of levodopa.The recent resurgence of surgery was initiated by adrenal medullary transplantation. The premise of adrenal medullary transplants was that these cells, when transplanted into patients with advanced PD, would survive and function as a new source of dopamine. The theoretical advantages of adrenal tissue include that the tissue comes from the patient, eliminating the issue of immunologic rejection; dopamine is a normal intermediate compound made by the chromaffin cells; and chromaffin cells may have neuritic morphology when grown in culture. The disadvantages include the non-neuronal source and the rather modest survival rates of cells in laboratory transplantation studies. Isolated case reports of effective treatment of advanced PD with unilateral transplantation of adrenal medullary cells into the striatum in the 1980s led to several clinical trials testing the safety and efficacy of this procedure.Fetal mesencephalon transplantation was introduced subsequently and is based on several considerations. First, PD is associated with relatively selective degeneration of dopaminergic cells located in the substantia nigra, a portion of the mesencephalon. Second, replacement of dopaminergic activity by means of precursor drugs, receptor agonists, or inhibitors of dopamine catabolism improves the signs and symptoms of PD. Third, laboratory evidence in experimental animals has demonstrated that grafts of dopamine-containing neurons improve behavioral models of PD. Fourth, in these animal models, grafts reinnervate the striatum and form synaptic connections with host neurons. As a result, a small number of research teams have developed programs for human fetal mesencephalic cell grafts in PD patients. Several published reports exist,...

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Chronic Electrical Stimulation of the VL-VPL Complex and of the Pallidum in the Treatment of Movement Disorders: Personal Experience since 1982

Cited by 127 publications

References 0 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

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

Evaluation of surgery for Parkinson’s disease

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