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Deep brain stimulation of the posterior subthalamic area in the treatment of tremor.
Acta Neurochir (Wien). 2009 Jan; 151(1):31-6.AN

Abstract

BACKGROUND

Several studies have described lesional therapy in the posterior subthalamic area (PSA) in the treatment of various movement disorders. Recently, some publications have illustrated the effect of deep brain stimulation (DBS) in this area in patients with Parkinson's disease, essential tremor, MS-tremor, and other forms of tremor. Even though the clinical series is small, the reported benefits prompted us to explore DBS in this area in the treatment of tremor.

METHOD

Five patients with tremor were operated using unilateral DBS of the PSA. Two patients had dystonic tremor, one primary writing tremor, one cerebellar tremor and the other neuropathic tremor. All patients were assessed before and 1 year after surgery using items 5 and 6 (tremor of the upper extremity), 11-14 (hand function), and when appropriate item 10 (handwriting) from the essential tremor rating scale.

FINDINGS

The mean improvement on stimulation after 1 year was 87%. A pronounced and sustained microlesional effect was seen in several of the patients, and while the mean improvement off stimulation was 56% the reduction in the three patients with the most pronounced effect was 89%. The two patients with dystonic tremor did also become free of the dystonic symptoms and pain in the treated arm. No severe complication occurred.

CONCLUSIONS

DBS of the PSA in this small group of patients had an excellent effect on the different forms of tremor, except for the neuropathic tremor where the effect was moderate. These preliminary results suggest PSA to be an effective target for the treatment of various forms of tremor. Further studies concerning indications, safety and efficacy of DBS in the posterior subthalamic area are required.

Authors+Show Affiliations

Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden. patric.blomstedt@neuro.umu.seNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19093072

Citation

Blomstedt, P, et al. "Deep Brain Stimulation of the Posterior Subthalamic Area in the Treatment of Tremor." Acta Neurochirurgica, vol. 151, no. 1, 2009, pp. 31-6.
Blomstedt P, Fytagoridis A, Tisch S. Deep brain stimulation of the posterior subthalamic area in the treatment of tremor. Acta Neurochir (Wien). 2009;151(1):31-6.
Blomstedt, P., Fytagoridis, A., & Tisch, S. (2009). Deep brain stimulation of the posterior subthalamic area in the treatment of tremor. Acta Neurochirurgica, 151(1), 31-6. https://doi.org/10.1007/s00701-008-0163-7
Blomstedt P, Fytagoridis A, Tisch S. Deep Brain Stimulation of the Posterior Subthalamic Area in the Treatment of Tremor. Acta Neurochir (Wien). 2009;151(1):31-6. PubMed PMID: 19093072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep brain stimulation of the posterior subthalamic area in the treatment of tremor. AU - Blomstedt,P, AU - Fytagoridis,A, AU - Tisch,S, Y1 - 2008/12/18/ PY - 2008/04/11/received PY - 2008/07/09/accepted PY - 2008/12/19/entrez PY - 2008/12/19/pubmed PY - 2009/4/10/medline SP - 31 EP - 6 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 151 IS - 1 N2 - BACKGROUND: Several studies have described lesional therapy in the posterior subthalamic area (PSA) in the treatment of various movement disorders. Recently, some publications have illustrated the effect of deep brain stimulation (DBS) in this area in patients with Parkinson's disease, essential tremor, MS-tremor, and other forms of tremor. Even though the clinical series is small, the reported benefits prompted us to explore DBS in this area in the treatment of tremor. METHOD: Five patients with tremor were operated using unilateral DBS of the PSA. Two patients had dystonic tremor, one primary writing tremor, one cerebellar tremor and the other neuropathic tremor. All patients were assessed before and 1 year after surgery using items 5 and 6 (tremor of the upper extremity), 11-14 (hand function), and when appropriate item 10 (handwriting) from the essential tremor rating scale. FINDINGS: The mean improvement on stimulation after 1 year was 87%. A pronounced and sustained microlesional effect was seen in several of the patients, and while the mean improvement off stimulation was 56% the reduction in the three patients with the most pronounced effect was 89%. The two patients with dystonic tremor did also become free of the dystonic symptoms and pain in the treated arm. No severe complication occurred. CONCLUSIONS: DBS of the PSA in this small group of patients had an excellent effect on the different forms of tremor, except for the neuropathic tremor where the effect was moderate. These preliminary results suggest PSA to be an effective target for the treatment of various forms of tremor. Further studies concerning indications, safety and efficacy of DBS in the posterior subthalamic area are required. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/19093072/Deep_brain_stimulation_of_the_posterior_subthalamic_area_in_the_treatment_of_tremor_ L2 - https://dx.doi.org/10.1007/s00701-008-0163-7 DB - PRIME DP - Unbound Medicine ER -