Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia.

Abstract

OBJECTIVE:

To report on the long-term outcomes of deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) in Parkinson disease (PD), essential tremor (ET), and dystonic tremor.

METHODS:

One hundred fifty-nine patients with PD, ET, and dystonia underwent VIM DBS due to refractory tremor at the Grenoble University Hospital. The primary outcome was a change in the tremor scores at 1 year after surgery and at the latest follow-up (21 years). Secondary outcomes included the relationship between tremor score reduction over time and the active contact position. Tremor scores (Unified Parkinson's Disease Rating Scale-III, items 20 and 21; Fahn, Tolosa, Marin Tremor Rating Scale) and the coordinates of the active contacts were recorded.

RESULTS:

Ninety-eight patients were included. Patients with PD and ET had sustained improvement in tremor with VIM stimulation (mean improvement, 70% and 66% at 1 year; 63% and 48% beyond 10 years, respectively; p < 0.05). There was no significant loss of stimulation benefit over time (p > 0.05). Patients with dystonia exhibited a moderate response at 1-year follow-up (41% tremor improvement, p = 0.027), which was not sustained after 5 years (30% improvement, p = 0.109). The more dorsal active contacts' coordinates in the right lead were related to a better outcome 1 year after surgery (p = 0.029). During the whole follow-up, forty-eight patients (49%) experienced minor side effects, whereas 2 (2.0%) had serious events (brain hemorrhage and infection).

CONCLUSIONS:

VIM DBS is an effective long-term (beyond 10 years) treatment for tremor in PD and ET. Effects on dystonic tremor were modest and transient.

CLASSIFICATION OF EVIDENCE:

This provides Class IV evidence. It is an observational study.

• Authors: Rubens Gisbert Cury, Valerie Fraix, Anna Castrioto, Maricely Ambar Pérez Fernández, Paul Krack, Stephan Chabardes, Eric Seigneuret, Eduardo Joaquim Lopes Alho, Alim-Louis Benabid, Elena Moro
• Journal: Neurology (Neurology) Vol. 89 Issue 13 Pg. 1416-1423 (Sep 26 2017) ISSN: 1526-632X [Electronic] United States
• PMID: 28768840 (Publication Type: Journal Article)
• Copyright: © 2017 American Academy of Neurology.

Topics

• Adult
• Aged
• Deep Brain Stimulation (adverse effects)
• Dystonia (physiopathology, therapy)
• Essential Tremor (physiopathology, therapy)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Parkinson Disease (physiopathology, therapy)
• Retrospective Studies
• Treatment Outcome
• Ventral Thalamic Nuclei (physiopathology)