Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders

Abstract

Tremor was suppressed by test stimulation of the thalamic ventralis intermedius (VIM) nucleus at high frequency (130 Hz) during stereotaxy in nonanesthetized patients suffering from Parkinson's disease or essential tremor. Ventralis intermedius stimulation has since been used by the authors over the last 8 years as a treatment in 117 patients with movement disorders (80 cases of Parkinson's disease, 20 cases of essential tremor, and 17 cases of various dyskinesias and dystonias including four multiple sclerosis). Chronic electrodes were stereotactically implanted in the VIM and connected to a programmable stimulator. Results depend on the indication. In Parkinson's disease patients, tremor, but not bradykinesia and rigidity, was selectively suppressed for as long as 8 years. Administration of L-Dopa was decreased by more than 30% in 40 Parkinson's disease patients. In essential tremor patients, results were satisfactory but deteriorated with time in 18.5% of cases, mainly for patients who presented an action component of their but deteriorated with time in 18.5% of cases, mainly for patients who presented an action component of their tremor. In other types of dyskinesias (except multiple sclerosis), results were much less favorable. Fifty-nine patients underwent bilateral implantation and 14 other patients received implantation contralateral to a previous thalamotomy. Thirty-seven patients (31.6%) experienced minor side effects, which were always well tolerated and immediately reversible. Three secondary scalp infections led to temporary removal of the implanted material. There was no permanent morbidity. This tremor suppression effect could be due to the inhibition or jamming of a retroactive loop. Chronic VIM stimulation, which is reversible, adaptable, and well tolerated even by patients undergoing bilateral surgery (74 of 117 patients) and by elderly patients, should replace thalamotomy in the regular surgical treatment of parkinsonian and essential tremors.

Sources and effects of electrode impedance during deep brain stimulation

“…Deep brain stimulation (DBS) represents an established therapy for essential tremor (Benabid et al, 1996), Parkinson's disease (Obeso et al, 2001), and dystonia (Vidailhet et al, 2005). In addition, DBS shows promise in the treatment of epilepsy (Hodaie et al, 2002), obsessive-compulsive disorder (Gabriels et al, 2003), and depression (Mayberg et al, 2005).…”

Studies of stimulus parameters for seizure disruption using neural network simulations

“…Over the last three decades, excitation of the central nervous system in the form of deep brain stimulation via thin cylindrical electrodes or induction coupled stimulation of the vagus nerve has become an effective and accepted form of therapy for a variety of neurological diseases (Benabid et al 1994;Benabid et al 1996;Siegfried and Lipitz 1994;Penry and Dean 1990;Uthman et al 1990). Patients with epilepsy frequently undergo surgery for the placement of subdural monitoring electrodes to help with seizure localization.…”

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

“…, essential tremor (Benabid et al, 1996) and dystonia (Vidailhet et al, 2005). It has also been used to treat various other neurological conditions including depression (Mayberg et al, 2005), obsessive-compulsive disorder (Gabriels et al, 2003) and epilepsy (Hodaie et al, 2002).…”