Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor

Murata, Junko; Kitagawa, Mayumi; Uesugi, Haruo; Saito, Hisatoshi; Iwasaki, Yoshinobu; Kikuchi, Seiji; Tashiro, Kunio; Sawamura, Yutaka

doi:10.3171/jns.2003.99.4.0708

Cited by 162 publications

(139 citation statements)

References 27 publications

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“…Correct targeting of the ventro-lateral thalamus has been reported to result in insufficient intraoperative tremor control [6,29,36,37,64], and superior effects on severe intention tremor in ET and MS have been ascribed to DBS in the posterior subthalamic white matter [3,36,45,48,53]. In one of our patients we did not achieve sufficient tremor control until the left electrode which had been inserted properly into the ventro-lateral thalamus was repositioned to be finally placed into the subthalamic area [21].…”

Section: Discussionmentioning

confidence: 99%

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%

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

View full text Add to dashboard Cite

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“…Complete resolution of the tremor was reported, and there were no adverse events that did not resolve with stimulation adjustments. In a second article, 29 the same investigators reported eight ET patients with medication-resistant proximal tremor who received unilateral DBS of the posterior part of the subthalamic white matter which included the zona incerta and prelemniscal radiation. They reported a mean improvement of 81% in both distal and proximal arm tremor, as well as an improvement in head and voice tremor.…”

mentioning

confidence: 99%

“…No major complications were reported. 29 Another study reported four ET patients with medication-resistant tremor who received bilateral DBS of the subthalamic region. 30 At 12 months after surgery, there were improvements of 81% in overall tremor, 83% in upper extremity tremor, 89% in activities of daily living, 67% in drawing spirals, 77% in pouring water, 58% in line drawing, and 68% in handwriting.…”

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confidence: 99%

Deep Brain Stimulation and Tremor

2008

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Summary: Deep brain stimulation (DBS) has been used to treat various tremor disorders for several decades. Medicationresistant, disabling essential tremor (ET) is the most common tremor disorder treated with DBS. The treatment has been consistently reported to result in significant benefit in upper extremity, as well as head and voice tremor, all of which were improved more dramatically with bilateral procedures. These benefits have been demonstrated to be sustained for up to 7 years. DBS has also been shown to be beneficial for the tremor associated with multiple sclerosis and post-traumatic tremor; however, fewer cases have been reported and the benefit is less consistent, less dramatic, and more transient than that seen with ET. The ventral intermediate nucleus of the thalamus is the most common DBS target for tremor disorders, but more recent studies have demonstrated benefits in tremor from DBS of the subthalamic area, primarily the zona incerta. Surgical complications are relatively uncommon and are generally less frequent than those seen with thalamotomy. Stimulation-related effects are usually mild and resolve with adjustment of stimulation parameters. DBS is thus a relatively safe and effective treatment for tremor disorders, particularly for medication-resistant, disabling ET, but may also have some role in medicationresistant, disabling tremor associated with multiple sclerosis and traumatic head injury.

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“…1) Surgery in this area was effective in improving writing. 5) In our patient, writing was also observed to improve markedly after the final surgery (Fig. 2).…”

Section: Discussionmentioning

confidence: 81%

“…Therefore, intervention in the posteromedial subthalamic area including the ZI may improve proximal tremor that is refractory to Vim thalamotomy. 5) Thalamic surgery in patients with multiple sclerosis had obtained tremor suppression by lower stimulation voltages within 13 mm of the thalamic target along the trajectory. 1) This area is located ventral to the VL, posteromedial to the STN, and lateral to the red nucleus.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Injury of the Subthalamic Area During Stereotactic Surgery Followed by Improvement of Trunk, Neck, and Face Tremor-Case Report-

Hirashima

Ikeda

Asahi

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 50-year-old man had undergone right nucleus ventrointermedius (Vim) thalamotomy 1 year previously, resulting in the disappearance of left hand tremor. However, he presented with right distal and proximal tremor including the axial trunk, neck, and head. Deep brain stimulation (DBS) of the left Vim for these symptoms was unsuccessful. Attempts were made to stimulate the left Vim, nucleus ventralis lateralis, and subthalamic nucleus (STN), but no significant improvement was obtained after repeat surgery. However, subsequent improvement of the symptoms including proximal tremor was very marked even without DBS stimulation. Brain magnetic resonance imaging demonstrated lesion and edema in the posteromedial area of the STN. Mechanical injury of the area caused by the surgical procedures may have contributed to the improvement in his persistent symptoms.

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Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor

Cited by 162 publications

References 27 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

Deep Brain Stimulation and Tremor

Mechanical Injury of the Subthalamic Area During Stereotactic Surgery Followed by Improvement of Trunk, Neck, and Face Tremor-Case Report-

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