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Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia.
Neurology. 2017 Sep 26; 89(13):1416-1423.Neur

Abstract

OBJECTIVE

To report on the long-term outcomes of deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) in Parkinson disease (PD), essential tremor (ET), and dystonic tremor.

METHODS

One hundred fifty-nine patients with PD, ET, and dystonia underwent VIM DBS due to refractory tremor at the Grenoble University Hospital. The primary outcome was a change in the tremor scores at 1 year after surgery and at the latest follow-up (21 years). Secondary outcomes included the relationship between tremor score reduction over time and the active contact position. Tremor scores (Unified Parkinson's Disease Rating Scale-III, items 20 and 21; Fahn, Tolosa, Marin Tremor Rating Scale) and the coordinates of the active contacts were recorded.

RESULTS

Ninety-eight patients were included. Patients with PD and ET had sustained improvement in tremor with VIM stimulation (mean improvement, 70% and 66% at 1 year; 63% and 48% beyond 10 years, respectively; p < 0.05). There was no significant loss of stimulation benefit over time (p > 0.05). Patients with dystonia exhibited a moderate response at 1-year follow-up (41% tremor improvement, p = 0.027), which was not sustained after 5 years (30% improvement, p = 0.109). The more dorsal active contacts' coordinates in the right lead were related to a better outcome 1 year after surgery (p = 0.029). During the whole follow-up, forty-eight patients (49%) experienced minor side effects, whereas 2 (2.0%) had serious events (brain hemorrhage and infection).

CONCLUSIONS

VIM DBS is an effective long-term (beyond 10 years) treatment for tremor in PD and ET. Effects on dystonic tremor were modest and transient.

CLASSIFICATION OF EVIDENCE

This provides Class IV evidence. It is an observational study.

Authors+Show Affiliations

From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France.From the Service de Neurologie (R.G.C., V.F., A.C., M.A.P.F., E.M.), Service de Neurochirurgie (M.A.P.F., E.S.), Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, INSERM U1216, Grenoble, France; Department of Neurology (R.G.C., M.A.P.F., E.J.L.A.), School of Medicine, University of São Paulo, São Paulo, Brazil; Hospital Dr. Dario Contreras (M.A.P.F.), Santo Domingo, Republica Dominicana; Service de Neurologie (P.K., S.C.), CHU de Genève, Switzerland; and Clinatec (A.-L.B.), Centre Hospitalier Universitaire de Grenoble, France. elenamfmoro@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28768840

Citation

Cury, Rubens Gisbert, et al. "Thalamic Deep Brain Stimulation for Tremor in Parkinson Disease, Essential Tremor, and Dystonia." Neurology, vol. 89, no. 13, 2017, pp. 1416-1423.
Cury RG, Fraix V, Castrioto A, et al. Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia. Neurology. 2017;89(13):1416-1423.
Cury, R. G., Fraix, V., Castrioto, A., Pérez Fernández, M. A., Krack, P., Chabardes, S., Seigneuret, E., Alho, E. J. L., Benabid, A. L., & Moro, E. (2017). Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia. Neurology, 89(13), 1416-1423. https://doi.org/10.1212/WNL.0000000000004295
Cury RG, et al. Thalamic Deep Brain Stimulation for Tremor in Parkinson Disease, Essential Tremor, and Dystonia. Neurology. 2017 Sep 26;89(13):1416-1423. PubMed PMID: 28768840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thalamic deep brain stimulation for tremor in Parkinson disease, essential tremor, and dystonia. AU - Cury,Rubens Gisbert, AU - Fraix,Valerie, AU - Castrioto,Anna, AU - Pérez Fernández,Maricely Ambar, AU - Krack,Paul, AU - Chabardes,Stephan, AU - Seigneuret,Eric, AU - Alho,Eduardo Joaquim Lopes, AU - Benabid,Alim-Louis, AU - Moro,Elena, Y1 - 2017/08/02/ PY - 2017/02/03/received PY - 2017/06/05/accepted PY - 2017/8/5/pubmed PY - 2017/9/30/medline PY - 2017/8/4/entrez SP - 1416 EP - 1423 JF - Neurology JO - Neurology VL - 89 IS - 13 N2 - OBJECTIVE: To report on the long-term outcomes of deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) in Parkinson disease (PD), essential tremor (ET), and dystonic tremor. METHODS: One hundred fifty-nine patients with PD, ET, and dystonia underwent VIM DBS due to refractory tremor at the Grenoble University Hospital. The primary outcome was a change in the tremor scores at 1 year after surgery and at the latest follow-up (21 years). Secondary outcomes included the relationship between tremor score reduction over time and the active contact position. Tremor scores (Unified Parkinson's Disease Rating Scale-III, items 20 and 21; Fahn, Tolosa, Marin Tremor Rating Scale) and the coordinates of the active contacts were recorded. RESULTS: Ninety-eight patients were included. Patients with PD and ET had sustained improvement in tremor with VIM stimulation (mean improvement, 70% and 66% at 1 year; 63% and 48% beyond 10 years, respectively; p < 0.05). There was no significant loss of stimulation benefit over time (p > 0.05). Patients with dystonia exhibited a moderate response at 1-year follow-up (41% tremor improvement, p = 0.027), which was not sustained after 5 years (30% improvement, p = 0.109). The more dorsal active contacts' coordinates in the right lead were related to a better outcome 1 year after surgery (p = 0.029). During the whole follow-up, forty-eight patients (49%) experienced minor side effects, whereas 2 (2.0%) had serious events (brain hemorrhage and infection). CONCLUSIONS: VIM DBS is an effective long-term (beyond 10 years) treatment for tremor in PD and ET. Effects on dystonic tremor were modest and transient. CLASSIFICATION OF EVIDENCE: This provides Class IV evidence. It is an observational study. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/28768840/Thalamic_deep_brain_stimulation_for_tremor_in_Parkinson_disease_essential_tremor_and_dystonia_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&amp;pmid=28768840 DB - PRIME DP - Unbound Medicine ER -