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Unilateral Left Deep Brain Stimulation of the Caudal Zona Incerta Is Equally Effective on Voice Tremor as Bilateral Stimulation: Evidence from 7 Patients with Essential Tremor.
Stereotact Funct Neurosurg. 2018; 96(3):157-161.SF

Abstract

BACKGROUND/AIMS

Deep brain stimulation (DBS) is less effective on voice tremor than arm tremor, and it is generally assumed that successful voice tremor treatment requires bilateral DBS and possibly more precise thalamic stimulation. However, recent findings suggest that these assumptions should be reconsidered.

OBJECTIVES

To evaluate whether unilateral DBS targeting the caudal zona incerta (cZi) may be sufficient to alleviate voice tremor in patients with essential tremor, or whether bilateral stimulation is needed.

METHODS

Seven patients with voice tremor off stimulation were evaluated during bilateral stimulation using their clinical settings, and during unilateral left stimulation in iterations with increasing stimulation amplitude. Two expert listeners assessed voice tremor severity in all samples in a blinded procedure.

RESULTS

Six patients had comparable or better effects with unilateral left stimulation compared to bilateral stimulation. For the seventh patient, unilateral DBS at a slightly higher amplitude achieved similar results as bilateral DBS. Overall, high-amplitude stimulation did not appear to be beneficial on voice tremor.

CONCLUSIONS

Unilateral left and bilateral cZi-DBS had comparable effects on voice tremor in the investigated group of 7 patients. This finding suggests that the assumption that bilateral DBS is required to treat voice tremor may need to be reconsidered.

Authors+Show Affiliations

Department of Clinical Science, Umeå University, Umeå, Sweden.Department of Clinical Science, Umeå University, Umeå, Sweden.Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29975951

Citation

Sandström, Linda, et al. "Unilateral Left Deep Brain Stimulation of the Caudal Zona Incerta Is Equally Effective On Voice Tremor as Bilateral Stimulation: Evidence From 7 Patients With Essential Tremor." Stereotactic and Functional Neurosurgery, vol. 96, no. 3, 2018, pp. 157-161.
Sandström L, Karlsson F, Blomstedt P. Unilateral Left Deep Brain Stimulation of the Caudal Zona Incerta Is Equally Effective on Voice Tremor as Bilateral Stimulation: Evidence from 7 Patients with Essential Tremor. Stereotact Funct Neurosurg. 2018;96(3):157-161.
Sandström, L., Karlsson, F., & Blomstedt, P. (2018). Unilateral Left Deep Brain Stimulation of the Caudal Zona Incerta Is Equally Effective on Voice Tremor as Bilateral Stimulation: Evidence from 7 Patients with Essential Tremor. Stereotactic and Functional Neurosurgery, 96(3), 157-161. https://doi.org/10.1159/000489938
Sandström L, Karlsson F, Blomstedt P. Unilateral Left Deep Brain Stimulation of the Caudal Zona Incerta Is Equally Effective On Voice Tremor as Bilateral Stimulation: Evidence From 7 Patients With Essential Tremor. Stereotact Funct Neurosurg. 2018;96(3):157-161. PubMed PMID: 29975951.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unilateral Left Deep Brain Stimulation of the Caudal Zona Incerta Is Equally Effective on Voice Tremor as Bilateral Stimulation: Evidence from 7 Patients with Essential Tremor. AU - Sandström,Linda, AU - Karlsson,Fredrik, AU - Blomstedt,Patric, Y1 - 2018/07/04/ PY - 2017/12/12/received PY - 2018/05/09/accepted PY - 2018/7/6/pubmed PY - 2019/4/12/medline PY - 2018/7/6/entrez KW - Bilateral stimulation KW - Caudal zona incerta KW - Deep brain stimulation KW - Essential tremor KW - Unilateral stimulation KW - Voice tremor SP - 157 EP - 161 JF - Stereotactic and functional neurosurgery JO - Stereotact Funct Neurosurg VL - 96 IS - 3 N2 - BACKGROUND/AIMS: Deep brain stimulation (DBS) is less effective on voice tremor than arm tremor, and it is generally assumed that successful voice tremor treatment requires bilateral DBS and possibly more precise thalamic stimulation. However, recent findings suggest that these assumptions should be reconsidered. OBJECTIVES: To evaluate whether unilateral DBS targeting the caudal zona incerta (cZi) may be sufficient to alleviate voice tremor in patients with essential tremor, or whether bilateral stimulation is needed. METHODS: Seven patients with voice tremor off stimulation were evaluated during bilateral stimulation using their clinical settings, and during unilateral left stimulation in iterations with increasing stimulation amplitude. Two expert listeners assessed voice tremor severity in all samples in a blinded procedure. RESULTS: Six patients had comparable or better effects with unilateral left stimulation compared to bilateral stimulation. For the seventh patient, unilateral DBS at a slightly higher amplitude achieved similar results as bilateral DBS. Overall, high-amplitude stimulation did not appear to be beneficial on voice tremor. CONCLUSIONS: Unilateral left and bilateral cZi-DBS had comparable effects on voice tremor in the investigated group of 7 patients. This finding suggests that the assumption that bilateral DBS is required to treat voice tremor may need to be reconsidered. SN - 1423-0372 UR - https://www.unboundmedicine.com/medline/citation/29975951/Unilateral_Left_Deep_Brain_Stimulation_of_the_Caudal_Zona_Incerta_Is_Equally_Effective_on_Voice_Tremor_as_Bilateral_Stimulation:_Evidence_from_7_Patients_with_Essential_Tremor_ L2 - https://www.karger.com?DOI=10.1159/000489938 DB - PRIME DP - Unbound Medicine ER -