Safety and efficacy of dual-lead thalamic deep brain stimulation for patients with treatment-refractory multiple sclerosis tremor: a single-centre, randomised, single-blind, pilot trial

Oliveria, Seth F.; Rodríguez, Ramón; Bowers, Dawn; Kantor, Daniel; Hilliard, Justin D.; Monari, Erin H.; Scott, Bonnie M.; Okun, Michael S.; Foote, Kelly D.

doi:10.1016/s1474-4422(17)30166-7

Cited by 69 publications

(60 citation statements)

References 18 publications

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“…Our results also support VOP as a therapeutic target, which, either alone or in combination with VIM DBS, has shown signs of efficacy for medication-refractory tremor related to multiple sclerosis. 36 Note that this study reported comparable efficacy between VIM and VOP DBS, whereas our results would have predicted higher efficacy of VOP stimulation. However, the patients in this DBS study differed from our lesion cases in terms of diagnosis (progressive or relapsingremitting multiple sclerosis vs focal stroke), number of lesions (multiple vs single), and clinical features (any type of tremor vs Holmes tremor).…”

contrasting

confidence: 42%

“…Our results suggest a slightly more medial GPi target could be beneficial. Our results also support VOP as a therapeutic target, which, either alone or in combination with VIM DBS, has shown signs of efficacy for medication‐refractory tremor related to multiple sclerosis . Note that this study reported comparable efficacy between VIM and VOP DBS, whereas our results would have predicted higher efficacy of VOP stimulation.…”

Section: Discussionmentioning

confidence: 99%

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Mapping holmes tremor circuit using the human brain connectome

Joutsa

Shih

Fox

2019

Annals of Neurology

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Objective Holmes tremor is a debilitating movement disorder with limited treatment options. Lesions causing Holmes tremor can occur in multiple different brain locations, leaving the neuroanatomical substrate unclear. Here, we test whether lesion locations that cause Holmes tremor map to a connected brain circuit and whether this circuit might serve as a useful therapeutic target. Methods Case reports of Holmes tremor caused by focal brain lesions were identified through a systematic literature search. Connectivity between each lesion location and the rest of the brain was computed using resting state functional connectivity magnetic resonance imaging data from 1,000 healthy volunteers. Commonalities across lesion locations were identified. This Holmes tremor circuit was then compared to neurosurgical treatment targets and clinical efficacy. Results We identified 36 lesions causing Holmes tremor, which were scattered across multiple different brain regions. However, all lesion locations were connected to a common brain circuit with nodes in the red nucleus, thalamus, globus pallidus, and cerebellum. In cases with effective neurosurgical treatment, the treatment target was connected with the lesion location, indicating that a second hit to the same circuit might be beneficial. Commonly used deep brain stimulation targets such as the ventral intermediate nucleus and subthalamic nucleus fell outside our Holmes tremor circuit, whereas the globus pallidus target was close, consistent with published clinical response rates for these targets. Interpretation Lesions causing Holmes tremor are part of a single connected brain circuit that may serve as an improved therapeutic target. ANN NEUROL 2019;86:812–820

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contrasting

confidence: 42%

Section: Discussionmentioning

confidence: 99%

Mapping holmes tremor circuit using the human brain connectome

Joutsa

Shih

Fox

2019

Annals of Neurology

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“…Several patients experienced AEs, encompassing MS exacerbation, seizures, intracerebral hematoma, gait/balance disturbance, asthenia and transient lower limb paresis, ataxia, dysarthria, paresthesias, and infections. Stimulation frequency ranged from 130 to 185 Hz, intensity from 0.5 to 8.0 V, and pulse width from 60 to 210 sec (Table 3)[25, 51–70]. …”

Section: Resultsmentioning

confidence: 99%

“…- Multiple sclerosis-associated tremor : dual-lead thalamic DBS (one targeting the VIM border and one targeting the ventralis oralis anterior-ventralis oralis posterior border) has the highest level of clinical trial support [70], providing better control likely by stimulating the major pathways involved in MS-associated tremor, cerebello-thalamo-cortical and pallidal pathways. Almost all studies reported the use of single monopolar stimulation, with a frequency ranging from 130 to 180 Hz and variable pulse width, ranging from 60 to 210 sec, but typically higher than other tremors.…”

Section: Discussionmentioning

confidence: 99%

Deep brain stimulation in uncommon tremor disorders: indications, targets, and programming

et al. 2018

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“…Another approach involves implantation of additional DBS electrodes, with separate or confined stimulation [11-14]. Recently, Oliveria et al [15] conducted a randomized clinical trial on dual lead thalamic stimulation in patients with refractory tremor secondary to multiple sclerosis, demonstrating an overall tremor reduction of 29.6% compared to baseline. Those patients had a second DBS electrode wire placed, allowing a potential doubling of the volume of tissue activation compared to a single DBS electrode wire.…”

Section: Introductionmentioning

confidence: 99%

Confined Thalamic Deep Brain Stimulation in Refractory Essential Tremor

Isaacs

Butler

Sukul

et al. 2018

Stereotact Funct Neurosurg

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Background: Thalamic ventral intermediate nucleus (VIM) deep brain stimulation (DBS) is an effective therapy for medication-refractory essential tremor (ET). However, 13–40% of patients with an initially robust tremor efficacy lose this benefit over time despite reprogramming attempts. At our institution, a cohort of ET patients with VIM DBS underwent implantation of a second anterior (ventralis oralis anterior; VOA) DBS lead to permit “confined stimulation.” We sought to assess whether confined stimulation conferred additional tremor capture compared to VIM or VOA stimulation alone. Methods: Seven patients participated in a protocol-based programming session during which a video-recorded Fahn-Tolosa-Marin Part A (FTM-A) tremor rating scale was used in the following 4 DBS states: off stimulation, VIM stimulation alone, VOA stimulation alone, and dual lead (confined) stimulation. Results: The average (SD) baseline FTM-A off score was 17.6 (4.0). VIM stimulation alone lowered the average FTM-A total score to 6.9 (4.0). Confined stimulation further attenuated the tremor, reducing the total score to 5.7 (2.8). Conclusions: Confined thalamic DBS can provide additional symptomatic benefits in patients with unsatisfactory tremor control from VIM or VOA stimulation alone.

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Safety and efficacy of dual-lead thalamic deep brain stimulation for patients with treatment-refractory multiple sclerosis tremor: a single-centre, randomised, single-blind, pilot trial

Cited by 69 publications

References 18 publications

Mapping holmes tremor circuit using the human brain connectome

Mapping holmes tremor circuit using the human brain connectome

Deep brain stimulation in uncommon tremor disorders: indications, targets, and programming

Confined Thalamic Deep Brain Stimulation in Refractory Essential Tremor

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