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Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor.
Acta Neurochir (Wien). 2007 Aug; 149(8):749-58; discussion 758.AN

Abstract

BACKGROUND

The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior.

PATIENTS AND METHODS

Eleven patients with disabling intention tremor of different etiology (essential tremor (n = 8), multiple sclerosis (n = 2) and one with, spinocerebellar ataxia) were implanted bilaterally with DBS electrodes targeted to the ventro-lateral thalamus using micro-recording and micro-stimulation. Among five tracks explored in parallel optimal tracks were chosen for permanent electrode implantation. Postoperative tremor suppression elicited by individual electrode contacts was quantified using a lateralised tremor rating scale at least 3 months (in most patients >1 year) after implantation. The position of electrode contacts was determined retrospectively from stereotactic X-ray exams and by correlation of pre- and postoperative MRI.

RESULTS

In all patients, DBS suppressed intention tremor markedly. On average, tremor on the left and right side of the body was improved by 68% (+/-19; standard deviation) and 73% (+/-21), respectively. In most patients, distal electrode contacts located in the subthalamic area proved to be more effective than proximal contacts in the ventro-lateral thalamus. In stereotactic coordinates, the optimal site was located 12.7 mm (+/-1.4; mean +/- standard deviation) lateral, 7.0 (+/-1.6) mm posterior, and 1.5 (+/-2.0) mm ventral to the mid-commissural point. In general, the best contacts could be selected for permanent stimulation. Nevertheless, in some instances, more proximal contacts had to be chosen because of adverse effects (paraesthesiae, dysarthria, gait ataxia) which were more pronounced with bilateral stimulation resulting in slightly less tremor suppression on the left and right side of body (63 +/- 18 and 68 +/- 19%, respectively).

CONCLUSION

Direct comparison of different stimulation sites in individual patients revealed that DBS in the subthalamic area is more effective in suppressing pharmacoresistant intention tremor than the ventro-lateral thalamus proper. Anatomical structures possibly involved in tremor suppression include cerebello-thalamic projections, the prelemniscal radiation, and the zona incerta.

Authors+Show Affiliations

Department of Neurosurgery, Christian-Albrechts-University, Kiel, Germany. w.hamel@uke.uni-hamburg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17660940

Citation

Hamel, W, et al. "Deep Brain Stimulation in the Subthalamic Area Is More Effective Than Nucleus Ventralis Intermedius Stimulation for Bilateral Intention Tremor." Acta Neurochirurgica, vol. 149, no. 8, 2007, pp. 749-58; discussion 758.
Hamel W, Herzog J, Kopper F, et al. Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor. Acta Neurochir (Wien). 2007;149(8):749-58; discussion 758.
Hamel, W., Herzog, J., Kopper, F., Pinsker, M., Weinert, D., Müller, D., Krack, P., Deuschl, G., & Mehdorn, H. M. (2007). Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor. Acta Neurochirurgica, 149(8), 749-58; discussion 758.
Hamel W, et al. Deep Brain Stimulation in the Subthalamic Area Is More Effective Than Nucleus Ventralis Intermedius Stimulation for Bilateral Intention Tremor. Acta Neurochir (Wien). 2007;149(8):749-58; discussion 758. PubMed PMID: 17660940.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor. AU - Hamel,W, AU - Herzog,J, AU - Kopper,F, AU - Pinsker,M, AU - Weinert,D, AU - Müller,D, AU - Krack,P, AU - Deuschl,G, AU - Mehdorn,H M, Y1 - 2007/08/01/ PY - 2006/10/06/received PY - 2007/03/19/accepted PY - 2007/7/31/pubmed PY - 2008/1/19/medline PY - 2007/7/31/entrez SP - 749-58; discussion 758 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 149 IS - 8 N2 - BACKGROUND: The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior. PATIENTS AND METHODS: Eleven patients with disabling intention tremor of different etiology (essential tremor (n = 8), multiple sclerosis (n = 2) and one with, spinocerebellar ataxia) were implanted bilaterally with DBS electrodes targeted to the ventro-lateral thalamus using micro-recording and micro-stimulation. Among five tracks explored in parallel optimal tracks were chosen for permanent electrode implantation. Postoperative tremor suppression elicited by individual electrode contacts was quantified using a lateralised tremor rating scale at least 3 months (in most patients >1 year) after implantation. The position of electrode contacts was determined retrospectively from stereotactic X-ray exams and by correlation of pre- and postoperative MRI. RESULTS: In all patients, DBS suppressed intention tremor markedly. On average, tremor on the left and right side of the body was improved by 68% (+/-19; standard deviation) and 73% (+/-21), respectively. In most patients, distal electrode contacts located in the subthalamic area proved to be more effective than proximal contacts in the ventro-lateral thalamus. In stereotactic coordinates, the optimal site was located 12.7 mm (+/-1.4; mean +/- standard deviation) lateral, 7.0 (+/-1.6) mm posterior, and 1.5 (+/-2.0) mm ventral to the mid-commissural point. In general, the best contacts could be selected for permanent stimulation. Nevertheless, in some instances, more proximal contacts had to be chosen because of adverse effects (paraesthesiae, dysarthria, gait ataxia) which were more pronounced with bilateral stimulation resulting in slightly less tremor suppression on the left and right side of body (63 +/- 18 and 68 +/- 19%, respectively). CONCLUSION: Direct comparison of different stimulation sites in individual patients revealed that DBS in the subthalamic area is more effective in suppressing pharmacoresistant intention tremor than the ventro-lateral thalamus proper. Anatomical structures possibly involved in tremor suppression include cerebello-thalamic projections, the prelemniscal radiation, and the zona incerta. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/17660940/Deep_brain_stimulation_in_the_subthalamic_area_is_more_effective_than_nucleus_ventralis_intermedius_stimulation_for_bilateral_intention_tremor_ L2 - https://dx.doi.org/10.1007/s00701-007-1230-1 DB - PRIME DP - Unbound Medicine ER -