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Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor.
Neurosurgery. 2006 Apr; 58(4 Suppl 2):ONS-280-5; discussion ONS-285-6.N

Abstract

OBJECTIVE

To report the results of ventralis intermedius nucleus/ventralis oralis posterior nucleus (VIM) plus ventralis oralis anterior (VOA)/ventralis oralis posterior (VOP) thalamic deep brain stimulation (DBS) for the treatment of posttraumatic and multiple sclerosis tremor.

OBJECTIVE

The treatment of posttraumatic tremor and multiple sclerosis tremor, by either medication or surgery, has proven difficult. Lesions and DBS have had mixed and somewhat disappointing results. Previously, we reported the use of two DBS electrodes (one at the VIM/VOP border and one at the VOA/VOP border) as effective for the treatment of posttraumatic tremor in a single patient. In this study, we report the results of this technique on four patients.

METHODS

Four patients with either posttraumatic tremor (n = 3) or multiple sclerosis tremor (n = 1) underwent placement of two DBS electrodes (one at the VIM/VOP border and one at the VOA/VOP border). Patients underwent preoperative testing and testing at a minimum of 6 months after implantation in four conditions: On VIM DBS/On VOA/VOP DBS; On VIM DBS/Off VOA VOP DBS (5 h DBS washout); Off VIM DBS/Off VOA/VOP DBS (12 h overnight washout); and Off VIM DBS/On VOA/VOP DBS (5 h DBS washout).

RESULTS

Each of the patients showed improvements in all four conditions when compared with the baseline. All of the improvements were maintained with chronic DBS, without tremor rebound. An analysis was performed to determine whether each condition was associated with symptom reduction (percentage change). The percentage reduction was significant for each condition and measure, despite the small number of participants. For the total tremor rating scale score, the Off VIM/Off VOA/VOP condition yielded less symptom reduction than the On VIM condition or the On VOA/VOP condition. The On VIM and On VOA/VOP conditions did not differ significantly from each other in terms of contralateral upper extremity symptoms or total clinical score. Activation of both the VIM and VOA/VOP electrodes was associated with the greatest symptom reduction.

CONCLUSION

Tremors, such as those examined in this study, that are refractory to medications and have a poor response to VIM DBS monotherapy, may respond favorably to VIM plus VOA/VOP DBS. Two electrodes may be better than one for the treatment of certain disorders; however, more study will be required to confirm this hypothesis.

Authors+Show Affiliations

Department of Neurology and Neurosurgery, University of Florida, Gainesville, Florida 32610, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

16582651

Citation

Foote, Kelly D., et al. "Dual Electrode Thalamic Deep Brain Stimulation for the Treatment of Posttraumatic and Multiple Sclerosis Tremor." Neurosurgery, vol. 58, no. 4 Suppl 2, 2006, pp. ONS-280-5; discussion ONS-285-6.
Foote KD, Seignourel P, Fernandez HH, et al. Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor. Neurosurgery. 2006;58(4 Suppl 2):ONS-280-5; discussion ONS-285-6.
Foote, K. D., Seignourel, P., Fernandez, H. H., Romrell, J., Whidden, E., Jacobson, C., Rodriguez, R. L., & Okun, M. S. (2006). Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor. Neurosurgery, 58(4 Suppl 2), ONS-280-5; discussion ONS-285-6.
Foote KD, et al. Dual Electrode Thalamic Deep Brain Stimulation for the Treatment of Posttraumatic and Multiple Sclerosis Tremor. Neurosurgery. 2006;58(4 Suppl 2):ONS-280-5; discussion ONS-285-6. PubMed PMID: 16582651.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor. AU - Foote,Kelly D, AU - Seignourel,Paul, AU - Fernandez,Hubert H, AU - Romrell,Janet, AU - Whidden,Elaine, AU - Jacobson,Charles, AU - Rodriguez,Ramon L, AU - Okun,Michael S, PY - 2006/4/4/pubmed PY - 2006/6/6/medline PY - 2006/4/4/entrez SP - ONS-280-5; discussion ONS-285-6 JF - Neurosurgery JO - Neurosurgery VL - 58 IS - 4 Suppl 2 N2 - OBJECTIVE: To report the results of ventralis intermedius nucleus/ventralis oralis posterior nucleus (VIM) plus ventralis oralis anterior (VOA)/ventralis oralis posterior (VOP) thalamic deep brain stimulation (DBS) for the treatment of posttraumatic and multiple sclerosis tremor. OBJECTIVE: The treatment of posttraumatic tremor and multiple sclerosis tremor, by either medication or surgery, has proven difficult. Lesions and DBS have had mixed and somewhat disappointing results. Previously, we reported the use of two DBS electrodes (one at the VIM/VOP border and one at the VOA/VOP border) as effective for the treatment of posttraumatic tremor in a single patient. In this study, we report the results of this technique on four patients. METHODS: Four patients with either posttraumatic tremor (n = 3) or multiple sclerosis tremor (n = 1) underwent placement of two DBS electrodes (one at the VIM/VOP border and one at the VOA/VOP border). Patients underwent preoperative testing and testing at a minimum of 6 months after implantation in four conditions: On VIM DBS/On VOA/VOP DBS; On VIM DBS/Off VOA VOP DBS (5 h DBS washout); Off VIM DBS/Off VOA/VOP DBS (12 h overnight washout); and Off VIM DBS/On VOA/VOP DBS (5 h DBS washout). RESULTS: Each of the patients showed improvements in all four conditions when compared with the baseline. All of the improvements were maintained with chronic DBS, without tremor rebound. An analysis was performed to determine whether each condition was associated with symptom reduction (percentage change). The percentage reduction was significant for each condition and measure, despite the small number of participants. For the total tremor rating scale score, the Off VIM/Off VOA/VOP condition yielded less symptom reduction than the On VIM condition or the On VOA/VOP condition. The On VIM and On VOA/VOP conditions did not differ significantly from each other in terms of contralateral upper extremity symptoms or total clinical score. Activation of both the VIM and VOA/VOP electrodes was associated with the greatest symptom reduction. CONCLUSION: Tremors, such as those examined in this study, that are refractory to medications and have a poor response to VIM DBS monotherapy, may respond favorably to VIM plus VOA/VOP DBS. Two electrodes may be better than one for the treatment of certain disorders; however, more study will be required to confirm this hypothesis. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/16582651/Dual_electrode_thalamic_deep_brain_stimulation_for_the_treatment_of_posttraumatic_and_multiple_sclerosis_tremor_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.NEU.0000192692.95455.FD DB - PRIME DP - Unbound Medicine ER -