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Bilateral stimulation of the caudal zona incerta nucleus for tremor control.
J Neurol Neurosurg Psychiatry. 2008 May; 79(5):504-13.JN

Abstract

INTRODUCTION

The ventrolateral (VL) nucleus of the thalamus is the commonly chosen target for deep brain stimulation (DBS) to alleviate tremor. However, it has a poor efficacy in alleviating proximal tremor and patients may develop tolerance to the action component of tremor. We performed bilateral stimulation of the caudal or motor part of the zona incerta nucleus (cZI) to determine its safety and efficacy in alleviating tremor.

METHODS

5 patients with parkinsonian tremor and 13 with a range of tremors (Holmes (HT), cerebellar (CT), essential (ET), multiple sclerosis (MS) and dystonic tremor (DT)) affecting both the proximal and distal body parts underwent MRI guided, bilateral cZI DBS. Tremor was assessed by the Fahn-Tolosa-Marin (FTM) tremor scale at baseline and at a mean follow-up of 12 months.

RESULTS

Resting PD tremor improved by 94.8% and postural tremor by 88.2%. The total tremor score improved by 75.9% in 6 patients with ET. HT improved by 70.2%, proximal CT by 60.4% and proximal MS tremor by 57.2% in the total tremor rating score. In the single patient with DT, there was improvement in both the dystonia and the tremor. Patients required low voltages of high-frequency stimulation and did not develop tolerance to it. Stimulation-related side effects were transient.

CONCLUSION

This prospective study shows that the cZI may be an alternative target for the treatment of tremor with DBS. In contrast to bilateral DBS of the VL nucleus, it improves all components of tremor affecting both the distal and proximal limbs as well as the axial musculature.

Authors+Show Affiliations

Institute of Neurosciences, Frenchay Hospital, Bristol BS16 1LE, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18037630

Citation

Plaha, P, et al. "Bilateral Stimulation of the Caudal Zona Incerta Nucleus for Tremor Control." Journal of Neurology, Neurosurgery, and Psychiatry, vol. 79, no. 5, 2008, pp. 504-13.
Plaha P, Khan S, Gill SS. Bilateral stimulation of the caudal zona incerta nucleus for tremor control. J Neurol Neurosurg Psychiatry. 2008;79(5):504-13.
Plaha, P., Khan, S., & Gill, S. S. (2008). Bilateral stimulation of the caudal zona incerta nucleus for tremor control. Journal of Neurology, Neurosurgery, and Psychiatry, 79(5), 504-13.
Plaha P, Khan S, Gill SS. Bilateral Stimulation of the Caudal Zona Incerta Nucleus for Tremor Control. J Neurol Neurosurg Psychiatry. 2008;79(5):504-13. PubMed PMID: 18037630.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bilateral stimulation of the caudal zona incerta nucleus for tremor control. AU - Plaha,P, AU - Khan,S, AU - Gill,S S, Y1 - 2007/11/23/ PY - 2007/11/27/pubmed PY - 2008/4/30/medline PY - 2007/11/27/entrez SP - 504 EP - 13 JF - Journal of neurology, neurosurgery, and psychiatry JO - J Neurol Neurosurg Psychiatry VL - 79 IS - 5 N2 - INTRODUCTION: The ventrolateral (VL) nucleus of the thalamus is the commonly chosen target for deep brain stimulation (DBS) to alleviate tremor. However, it has a poor efficacy in alleviating proximal tremor and patients may develop tolerance to the action component of tremor. We performed bilateral stimulation of the caudal or motor part of the zona incerta nucleus (cZI) to determine its safety and efficacy in alleviating tremor. METHODS: 5 patients with parkinsonian tremor and 13 with a range of tremors (Holmes (HT), cerebellar (CT), essential (ET), multiple sclerosis (MS) and dystonic tremor (DT)) affecting both the proximal and distal body parts underwent MRI guided, bilateral cZI DBS. Tremor was assessed by the Fahn-Tolosa-Marin (FTM) tremor scale at baseline and at a mean follow-up of 12 months. RESULTS: Resting PD tremor improved by 94.8% and postural tremor by 88.2%. The total tremor score improved by 75.9% in 6 patients with ET. HT improved by 70.2%, proximal CT by 60.4% and proximal MS tremor by 57.2% in the total tremor rating score. In the single patient with DT, there was improvement in both the dystonia and the tremor. Patients required low voltages of high-frequency stimulation and did not develop tolerance to it. Stimulation-related side effects were transient. CONCLUSION: This prospective study shows that the cZI may be an alternative target for the treatment of tremor with DBS. In contrast to bilateral DBS of the VL nucleus, it improves all components of tremor affecting both the distal and proximal limbs as well as the axial musculature. SN - 1468-330X UR - https://www.unboundmedicine.com/medline/citation/18037630/Bilateral_stimulation_of_the_caudal_zona_incerta_nucleus_for_tremor_control_ L2 - https://jnnp.bmj.com/lookup/pmidlookup?view=long&pmid=18037630 DB - PRIME DP - Unbound Medicine ER -