Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor

Autor: D. Weinert, M. O. Pinsker, Günther Deuschl, Jan Herzog, F. Kopper, Hubertus Maximilian Mehdorn, Paul Krack, Dieter Müller, Wolfgang Hamel
Jazyk: angličtina
Rok vydání: 2007
Předmět:
Male
medicine.medical_specialty
Deep Brain Stimulation/*methods
Neurology
Deep brain stimulation
Multiple Sclerosis
Multiple Sclerosis/physiopathology/therapy
medicine.medical_treatment
Deep Brain Stimulation
Thalamus
Subthalamic Nucleus/*physiopathology
Stimulation
Stereotaxic Techniques
Subthalamic Nucleus
Tremor
Ventral Thalamic Nuclei/*physiopathology
Medicine
Spinocerebellar Ataxias
Humans
Dominance
Cerebral
Aged
Retrospective Studies
Neurons
Ventral Thalamic Nuclei
business.industry
Middle Aged
Magnetic Resonance Imaging
Electrodes
Implanted
body regions
medicine.anatomical_structure
Treatment Outcome
nervous system
Dominance
Cerebral/*physiology
Tremor/etiology/physiopathology/*therapy
Anesthesia
Stereotaxic technique
Spinocerebellar Ataxias/physiopathology/therapy
Zona incerta
Surgery
Intention tremor
Female
Neurology (clinical)
Neurosurgery
medicine.symptom
business
Neuroscience
Microelectrodes
Follow-Up Studies
Zdroj: Acta Neurochirurgica, Vol. 149, No 8 (2007) pp. 749-758; discussion 758
ISSN: 0001-6268
Popis: The ventro-lateral thalamus is the stereotactic target of choice for severe intention tremor. Nevertheless, the optimal target area has remained controversial, and targeting of the subthalamic area has been suggested to be superior.Eleven patients with disabling intention tremor of different etiology (essential tremor (n = 8), multiple sclerosis (n = 2) and one with, spinocerebellar ataxia) were implanted bilaterally with DBS electrodes targeted to the ventro-lateral thalamus using micro-recording and micro-stimulation. Among five tracks explored in parallel optimal tracks were chosen for permanent electrode implantation. Postoperative tremor suppression elicited by individual electrode contacts was quantified using a lateralised tremor rating scale at least 3 months (in most patients1 year) after implantation. The position of electrode contacts was determined retrospectively from stereotactic X-ray exams and by correlation of pre- and postoperative MRI.In all patients, DBS suppressed intention tremor markedly. On average, tremor on the left and right side of the body was improved by 68% (+/-19; standard deviation) and 73% (+/-21), respectively. In most patients, distal electrode contacts located in the subthalamic area proved to be more effective than proximal contacts in the ventro-lateral thalamus. In stereotactic coordinates, the optimal site was located 12.7 mm (+/-1.4; mean +/- standard deviation) lateral, 7.0 (+/-1.6) mm posterior, and 1.5 (+/-2.0) mm ventral to the mid-commissural point. In general, the best contacts could be selected for permanent stimulation. Nevertheless, in some instances, more proximal contacts had to be chosen because of adverse effects (paraesthesiae, dysarthria, gait ataxia) which were more pronounced with bilateral stimulation resulting in slightly less tremor suppression on the left and right side of body (63 +/- 18 and 68 +/- 19%, respectively).Direct comparison of different stimulation sites in individual patients revealed that DBS in the subthalamic area is more effective in suppressing pharmacoresistant intention tremor than the ventro-lateral thalamus proper. Anatomical structures possibly involved in tremor suppression include cerebello-thalamic projections, the prelemniscal radiation, and the zona incerta.
Databáze: OpenAIRE
Externí odkaz: