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Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor.
Parkinsonism Relat Disord. 2012 Dec; 18(10):1062-6.PR

Abstract

BACKGROUND

The subthalamic nucleus is currently the target of choice in deep brain stimulation (DBS) for Parkinson's disease (PD), while thalamic DBS is used in some cases of tremor-dominant PD. Recently, a number of studies have presented promising results from DBS in the posterior subthalamic area, including the caudal zona incerta (cZi). The aim of the current study was to evaluate cZi DBS in tremor-dominant Parkinson's disease.

METHODS

14 patients with predominately unilateral tremor-dominant PD and insufficient relief from pharmacologic therapy were included and evaluated according to the motor part of the Unified Parkinson Disease Rating Scale (UPDRS). The mean age was 65 ± 6.1 years and the disease duration 7 ± 5.7 years. Thirteen patients were operated on with unilateral cZi DBS and 1 patient with a bilateral staged procedure. Five patients had non-L-dopa responsive symptoms. The patients were evaluated on/off medication before surgery and on/off medication and stimulation after a minimum of 12 months after surgery.

RESULTS

At the follow-up after a mean of 18.1 months stimulation in the off-medication state improved the contralateral UPDRS III score by 47.7%. Contralateral tremor, rigidity, and bradykinesia were improved by 82.2%, 34.3%, and 26.7%, respectively. Stimulation alone abolished tremor at rest in 10 (66.7%) and action tremor in 8 (53.3%) of the patients.

CONCLUSION

Unilateral cZi DBS seems to be safe and effective for patients with severe Parkinsonian tremor. The effects on rigidity and bradykinesia were, however, not as profound as in previous reports of DBS in this area.

Authors+Show Affiliations

Department of Pharmacology and Clinical Neuroscience, Division of Neurosurgery, Umeå University, Umeå, Sweden. patric.blomstedt@neuro.umu.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22709794

Citation

Blomstedt, Patric, et al. "Unilateral Caudal Zona Incerta Deep Brain Stimulation for Parkinsonian Tremor." Parkinsonism & Related Disorders, vol. 18, no. 10, 2012, pp. 1062-6.
Blomstedt P, Fytagoridis A, Åström M, et al. Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor. Parkinsonism Relat Disord. 2012;18(10):1062-6.
Blomstedt, P., Fytagoridis, A., Åström, M., Linder, J., Forsgren, L., & Hariz, M. I. (2012). Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor. Parkinsonism & Related Disorders, 18(10), 1062-6. https://doi.org/10.1016/j.parkreldis.2012.05.024
Blomstedt P, et al. Unilateral Caudal Zona Incerta Deep Brain Stimulation for Parkinsonian Tremor. Parkinsonism Relat Disord. 2012;18(10):1062-6. PubMed PMID: 22709794.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor. AU - Blomstedt,Patric, AU - Fytagoridis,Anders, AU - Åström,Mattias, AU - Linder,Jan, AU - Forsgren,Lars, AU - Hariz,Marwan I, Y1 - 2012/06/17/ PY - 2012/02/15/received PY - 2012/04/30/revised PY - 2012/05/23/accepted PY - 2012/6/20/entrez PY - 2012/6/20/pubmed PY - 2013/5/23/medline SP - 1062 EP - 6 JF - Parkinsonism & related disorders JO - Parkinsonism Relat Disord VL - 18 IS - 10 N2 - BACKGROUND: The subthalamic nucleus is currently the target of choice in deep brain stimulation (DBS) for Parkinson's disease (PD), while thalamic DBS is used in some cases of tremor-dominant PD. Recently, a number of studies have presented promising results from DBS in the posterior subthalamic area, including the caudal zona incerta (cZi). The aim of the current study was to evaluate cZi DBS in tremor-dominant Parkinson's disease. METHODS: 14 patients with predominately unilateral tremor-dominant PD and insufficient relief from pharmacologic therapy were included and evaluated according to the motor part of the Unified Parkinson Disease Rating Scale (UPDRS). The mean age was 65 ± 6.1 years and the disease duration 7 ± 5.7 years. Thirteen patients were operated on with unilateral cZi DBS and 1 patient with a bilateral staged procedure. Five patients had non-L-dopa responsive symptoms. The patients were evaluated on/off medication before surgery and on/off medication and stimulation after a minimum of 12 months after surgery. RESULTS: At the follow-up after a mean of 18.1 months stimulation in the off-medication state improved the contralateral UPDRS III score by 47.7%. Contralateral tremor, rigidity, and bradykinesia were improved by 82.2%, 34.3%, and 26.7%, respectively. Stimulation alone abolished tremor at rest in 10 (66.7%) and action tremor in 8 (53.3%) of the patients. CONCLUSION: Unilateral cZi DBS seems to be safe and effective for patients with severe Parkinsonian tremor. The effects on rigidity and bradykinesia were, however, not as profound as in previous reports of DBS in this area. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/22709794/Unilateral_caudal_zona_incerta_deep_brain_stimulation_for_Parkinsonian_tremor_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1353-8020(12)00233-7 DB - PRIME DP - Unbound Medicine ER -