Successful thalamic deep brain stimulation for orthostatic tremor

Guridi, Jorge; Rodriguez-Oroz, María C.; Arbizu, Javier; Alegre, Manuel; Prieto, Elena; Landecho, Ignacio; Manrique, Manuel Jesús González; Artieda, Julio; Obeso, José A.

doi:10.1002/mds.22001

Cited by 88 publications

(87 citation statements)

References 10 publications

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“…Levodopa had no benefit on OT in any of the patients with a diagnosis of Parkinsonism. Thalamic DBS was helpful in few cases but less efficient than in other tremors [113,114].…”

Section: Treatment Of Otmentioning

confidence: 94%

The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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Tremor is a hyperkinetic movement disorder characterized by rhythmic oscillations of one or more body parts. It can be disabling and may impair quality of life. Various etiological subtypes of tremor are recognized, with essential tremor (ET) and Parkinsonian tremor being the most common. Here we review the current literature on tremor treatment regarding ET and head and voice tremor, as well as dystonic tremor, orthostatic tremor, tremor due to multiple sclerosis (MS) or lesions in the brainstem or thalamus, neuropathic tremor, and functional (psychogenic) tremor, and summarize main findings. Most studies are available for ET and only few studies specifically focused on other tremor forms. Controlled trials outside ET are rare and hence most of the recommendations are based on a low level of evidence. For ET, propranolol and primidone are considered drugs of first choice with a mean effect size of approximately 50 % tremor reduction. The efficacy of topiramate is also supported by a large double-blind placebocontrolled trial, while other drugs have less supporting evidence. With a mean effect size of about 90 % deep brain stimulation in the nucleus ventralis intermedius or the subthalamic nucleus may be the most potent treatment; however, there are no controlled trials and it is reserved for severely affected patients. Dystonic limb tremor may respond to anticholinergics. Botulinum toxin improves head and voice tremor. Gabapentin and clonazepam are often recommended for orthostatic tremor. MS tremor responds only poorly to drug treatment. For patients with severe MS tremor, thalamic deep brain stimulation has been recommended. Patients with functional tremor may benefit from antidepressants and are best be treated in a multidisciplinary setting. Several tremor syndromes can already be treated with success. But new drugs specifically designed for tremor treatment are needed. ET is most likely covering different entities and their delineation may also improve treatment. Modern study designs and long-term studies are needed.

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“…Levodopa had no benefit on OT in any of the patients with a diagnosis of Parkinsonism. Thalamic DBS was helpful in few cases but less efficient than in other tremors [113,114].…”

Section: Treatment Of Otmentioning

confidence: 94%

The Treatment of Tremor

Schneider

Deuschl

2014

Neurotherapeutics

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“…Including these patients there are now 9 published cases of bilateral Vim DBS successfully treating OT [5,6,7,8,9,10]. Only 1 case is published without sustained improvement [5].…”

Section: Discussionmentioning

confidence: 99%

“…Only 1 case is published without sustained improvement [5]. The degree of success after some surgeries is difficult to judge as these manuscripts provide only subjective outcomes [6,8,9,11]. A standardized, objective, patient-centered outcome measure such as standing time is easily performed and has been used in some reports (including ours) [5,7,10]; however, it has not been validated given the rarity of this condition.…”

Section: Discussionmentioning

confidence: 99%

“…Only 8 cases of Vim DBS for OT are published in the literature [5,6,7,8,9,10,11], 7 with sustained symptomatic benefit. Most reports are limited due to a lack of clear outcome measures [6,8,9,11], poor patient characterization [9], or information about the active contact or lead tip location [6,7,8,9,10] (table 1). We present 2 additional patients with OT who experienced meaningful symptomatic improvement after Vim DBS.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral Ventral Intermediate Nucleus Thalamic Deep Brain Stimulation in Orthostatic Tremor

Coleman

Starr²,

Katz³

et al. 2016

Stereotact Funct Neurosurg

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Background: Orthostatic tremor (OT) is characterized by high-frequency leg tremor when standing still, resulting in a sense of imbalance, with limited treatment options. Ventral intermediate (Vim) nucleus thalamic deep brain stimulation (DBS) has been reported as beneficial in a few cases. Objective: To report clinical outcomes, lead locations, and stimulation parameters in 2 patients with severe medication-refractory OT treated with Vim DBS. Methods: The patients underwent surface electromyography (EMG) to confirm the OT diagnosis. Outcomes were measured as change in tolerated standing time at the last follow-up. Lead locations were quantified using postoperative MRI. Results: Vim DBS was well tolerated and resulted in improvement in standing time (patient 1: 50 s at baseline to 15 min 16 months after surgery; patient 2: 34 s at baseline to 4.2 min 7 months after surgery). Postoperative surface EMG for patient 1 demonstrated a delayed onset of tremor, lower-amplitude tremor, and periods of quiescence, but an unchanged tremor frequency. Conclusion: These cases provide further support for Vim DBS to improve standing time in severe medication-refractory OT. The location of the effective thalamic target for OT does not differ from the effective target for essential tremor.

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“…Característicamente, ésta se intensifica al estar en bipedestación mientras que el sentarse, sujetarse a algo o deambular lo alivia; es necesaria la contracción isomé-trica de la musculatura inferior para que se desencadene el temblor 5 . La causa es desconocida y parece originarse en un generador supraespinal localizado en el tronco del encé-falo influenciado por la actividad descontrolada del circuito tálamo-cortical 6 . En el 75% de los casos es idiopático y en el 25% asocian alteraciones neurológicas adicionales 7 que por frecuencia son parkinsonismo, síndrome de piernas inquietas, clonus, mioclonus y ataxia cerebelosa.…”

Section: Introductionunclassified

Temblor ortostático como causa de inestabilidad

Manrique-Huarte

Arcocha

Pérez‐Fernández

2012

Acta Otorrinolaringológica Española

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PALABRAS CLAVE Inestabilidad; Electromiografía; Temblor ortostáticoResumen El temblor ortostático (TO) es una enfermedad neurológica de origen desconocido caracterizada por un temblor de 10-20 Hz en las piernas en bipedestación. Se manifiesta por mareo e inestabilidad, que típicamente mejoran al apoyarse o sentarse y la ingesta de pequeñas cantidades de alcohol lo reduce de manera significativa. Se muestran 4 casos clí-nicos atendidos en nuestra consulta cuyo diagnóstico sugiere ser el de TO. Consideramos que ante un paciente con inestabilidad, es preciso plantearse como diagnóstico diferencial un TO. La historia clínica nos orienta hacia esta entidad y en caso de sospecha, el diagnóstico definitivo viene dado por el registro de la electromiografía en las extremidades inferiores en condición de reposo sentado y en ortostatismo donde se registra un temblor de 10-20 Hz. El tratamiento es médico y, se emplea el clonazepam como primera opción terapéu-tica. © 2011 Elsevier España, S.L. Todos los derechos reservados. KEYWORDS Instability; Electromyography; Orthostatic tremor Orthostatic tremor inducing instabilityAbstract Orthostatic tremor (OT) is a neurological disease of unknown aetiology. It is defined by the presence of a 10-20 Hz tremor in the legs while standing still. Symptoms described are dizziness and instability that diminish if the patient sits down or leans on something; drinking small amounts of alcohol significantly reduces OT. Due to the dizziness and/or unsteadiness, these patients are usually referred to the neuro-otology department. We report 4 cases diagnosed with OT. The diagnosis of OT should be considered for patients with instability. The clinical history is a key factor to suspect this entity, and the diagnosis is given by the register of 10-20 Hz contractions on limb electromyography. Treatment for this disease consists of medical treatment; the first option is clonazepam.

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Successful thalamic deep brain stimulation for orthostatic tremor

Cited by 88 publications

References 10 publications

The Treatment of Tremor

The Treatment of Tremor

Bilateral Ventral Intermediate Nucleus Thalamic Deep Brain Stimulation in Orthostatic Tremor

Temblor ortostático como causa de inestabilidad

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