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Neurology. 2017 Sep 26;89(13):1416-1423. doi: 10.1212/WNL.0000000000004295. Epub 2017 Aug 2.

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

Author information

1
From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.
2
From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France. elenamfmoro@gmail.com.

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.

PMID:
28768840
DOI:
10.1212/WNL.0000000000004295
[Indexed for MEDLINE]

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