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Deep Brain Stimulation for Essential Tremor: A Comparison of Targets.
World Neurosurg. 2018 Feb; 110:e580-e584.WN

Abstract

BACKGROUND

Deep brain stimulation (DBS) is an established treatment for refractory essential tremor (ET). Initially, the target of choice was the thalamic ventralis intermedius nucleus (VIM). However, the zona incerta (ZI) has been suggested as a superior target. Both targets are considered safe and effective, but a direct comparison between these targets is lacking.

METHODS

We analyzed a single-center cohort of 44 patients with ET treated with DBS between 1998 and 2017, targeting the VIM and/or ZI. Patient-reported outcome on the Washington Heights-Inwood Genetic Study of Essential Tremor rating scale, adverse events, and stimulation-induced side effects were assessed.

RESULTS

Patient-reported outcome of ZI DBS (-2.2 ± 1.2; 18 patients with 28 electrodes) was superior to VIM DBS (-1.2 ± 1.4; 10 patients with 19 electrodes) (P < 0.01). There was no difference in adverse events between implantations in VIM (45%) and ZI (46%). Dysarthria stimulation-induced side effects were significantly more often reported after VIM DBS (P = 0.01), whereas visual stimulation-induced side effects occurred more often after ZI DBS (P = 0.04).

CONCLUSIONS

In this study, ZI DBS was superior to VIM DBS in terms of patient-reported effectiveness. There was a comparable number of complications between both targets. This finding further supports ZI over VIM as the principal DBS target in essential tremor.

Authors+Show Affiliations

Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: j.m.c.van.dijk@umcg.nl.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29196249

Citation

Holslag, Joost A H., et al. "Deep Brain Stimulation for Essential Tremor: a Comparison of Targets." World Neurosurgery, vol. 110, 2018, pp. e580-e584.
Holslag JAH, Neef N, Beudel M, et al. Deep Brain Stimulation for Essential Tremor: A Comparison of Targets. World Neurosurg. 2018;110:e580-e584.
Holslag, J. A. H., Neef, N., Beudel, M., Drost, G., Oterdoom, D. L. M., Kremer, N. I., van Laar, T., & van Dijk, J. M. C. (2018). Deep Brain Stimulation for Essential Tremor: A Comparison of Targets. World Neurosurgery, 110, e580-e584. https://doi.org/10.1016/j.wneu.2017.11.064
Holslag JAH, et al. Deep Brain Stimulation for Essential Tremor: a Comparison of Targets. World Neurosurg. 2018;110:e580-e584. PubMed PMID: 29196249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep Brain Stimulation for Essential Tremor: A Comparison of Targets. AU - Holslag,Joost A H, AU - Neef,Nienke, AU - Beudel,Martijn, AU - Drost,Gea, AU - Oterdoom,D L Marinus, AU - Kremer,Naomi I, AU - van Laar,Teus, AU - van Dijk,J Marc C, Y1 - 2017/11/28/ PY - 2017/07/20/received PY - 2017/11/08/revised PY - 2017/11/11/accepted PY - 2017/12/3/pubmed PY - 2018/5/17/medline PY - 2017/12/3/entrez KW - Deep brain stimulation KW - Essential tremor KW - Ventralis intermedius nucleus KW - Zona incerta SP - e580 EP - e584 JF - World neurosurgery JO - World Neurosurg VL - 110 N2 - BACKGROUND: Deep brain stimulation (DBS) is an established treatment for refractory essential tremor (ET). Initially, the target of choice was the thalamic ventralis intermedius nucleus (VIM). However, the zona incerta (ZI) has been suggested as a superior target. Both targets are considered safe and effective, but a direct comparison between these targets is lacking. METHODS: We analyzed a single-center cohort of 44 patients with ET treated with DBS between 1998 and 2017, targeting the VIM and/or ZI. Patient-reported outcome on the Washington Heights-Inwood Genetic Study of Essential Tremor rating scale, adverse events, and stimulation-induced side effects were assessed. RESULTS: Patient-reported outcome of ZI DBS (-2.2 ± 1.2; 18 patients with 28 electrodes) was superior to VIM DBS (-1.2 ± 1.4; 10 patients with 19 electrodes) (P < 0.01). There was no difference in adverse events between implantations in VIM (45%) and ZI (46%). Dysarthria stimulation-induced side effects were significantly more often reported after VIM DBS (P = 0.01), whereas visual stimulation-induced side effects occurred more often after ZI DBS (P = 0.04). CONCLUSIONS: In this study, ZI DBS was superior to VIM DBS in terms of patient-reported effectiveness. There was a comparable number of complications between both targets. This finding further supports ZI over VIM as the principal DBS target in essential tremor. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29196249/Deep_Brain_Stimulation_for_Essential_Tremor:_A_Comparison_of_Targets_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)31987-3 DB - PRIME DP - Unbound Medicine ER -