Stimulation of the subthalamic region for essential tremor

Puneet Plaha Department of Neurosurgery, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, United Kingdom

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Nikunj K. Patel Department of Neurosurgery, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, United Kingdom

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Steven S. Gill Department of Neurosurgery, Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, United Kingdom

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Object. The goal of this study was to determine the safety and efficacy of bilateral subthalamic region stimulation in the treatment of essential tremor (ET).

Methods. Following induction of general anesthesia, four patients with disabling tremor that had proved to be refractory to pharmacotherapy underwent magnetic resonance imaging—guided deep brain stimulation (DBS) of the bilateral subthalamic region. Tremor was assessed by applying the Fahn-Tolosa-Marín Tremor Rating Scale at baseline and again at the 12-month follow-up examination.

Following surgery the total tremor score improved by 80.1% (from a baseline mean score of 63 ± 15.1 to a score of 11.8 ± 3.9 at 12 months postoperatively). There was a significant improvement (p < 0.0001) in the mean tremor score of the upper limb (postural and action component) from a baseline score of 3 ± 0.9 to a score of 0.5 ± 0.5 at 12 months postoperatively. In two patients with Score 4 head tremor complete arrest of the tremor was observed at 12 months. Motor function scores of the upper limb for drawing spirals, pouring water, and drawing lines improved significantly (p < 0.05) by 66.7, 76.9, and 58.3%, respectively. Handwriting improved by 68%, but this gain was not significant. The mean activities of daily living score at baseline was 20 ± 3.2; there was an 88.8% improvement in this score to 2.3 ± 1.5 at the 12-month evaluation. The voltage required for effective tremor control was low (mean 1.8 ± 0.2 V) and, along with the other parameters of DBS (frequency and pulse width), did not change significantly over the 12-month period. Tolerance to the action component of tremor was not seen. There was no procedural or stimulation-related complication.

Conclusions. Bilateral subthalamic region stimulation is effective in arresting tremor and head titubation, as well as functional disability in ET. Complications like dysarthria and disequilibrium were not seen. These patients required low voltages of stimulation and did not develop a tolerance to the treatment.

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