Long-term evaluation of deep brain stimulation of the thalamus

Rajesh PahwaUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Kelly E. LyonsUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Steven B. WilkinsonUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Richard K. Simpson Jr.University of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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William G. OndoUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Daniel TarsyUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Thorkild NorregaardUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Jean P. HubbleUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Donald A. SmithUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Robert A. HauserUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Joseph JankovicUniversity of Kansas Medical Center, Kansas City, Kansas; Baylor College of Medicine, Houston, Texas; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Novartis Pharmaceuticals, East Hanover, New Jersey; and University of South Florida, Tampa, Florida

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Object

The effects of thalamic deep brain stimulation (DBS) on essential tremor (ET) and Parkinson disease (PD) have been well documented, but there is a paucity of long-term data. The aim of this study was to evaluate the longterm safety and efficacy of DBS of the ventralis intermedius nucleus (VIM) of the thalamus for PD and ET.

Methods

Thirty-eight of 45 patients enrolled at five sites completed a 5-year follow-up study. There were 26 patients with ET and 19 with PD undergoing 29 unilateral (18 ET/11 PD) and 16 bilateral (eight ET/eight PD) procedures. Patients with ET were evaluated using the Tremor Rating Scale, and patients with PD were evaluated using the Unified Parkinson’s Disease Rating Scale. The mean age of patients with ET was 70.2 years and 66.3 years in patients with PD. Unilaterally implanted patients with ET had a 75% improvement of the targeted hand tremor; those with bilateral implants had a 65% improvement in the left hand and 86% in the right compared with baseline. Parkinsonian patients with unilateral implants had an 85% improvement in the targeted hand tremor and those with bilateral implants had a 100% improvement in the left hand and 90% improvement in the right. Common DBS-related adverse events in patients receiving unilateral implants were paresthesia (45%) and pain (41%), and in patients receiving implants bilaterally dysarthria (75%) and balance difficulties (56%) occurred. Device-related surgical revisions other than IPG replacements occurred in 12 (27%) of the 45 patients.

Conclusions

Thalamic stimulation is safe and effective for the long-term management of essential and parkinsonian tremors. Bilateral stimulation can cause dysarthria and incoordination and should be used cautiously.

Abbreviations used in this paper:

AC = anterior commissure; ADL = activities of daily living; DBS = deep brain stimulation; ET = essential tremor; IPG = implantable pulse generator; PC = posterior commissure; PD = Parkinson disease; TRS = Tremor Rating Scale; UPDRS = Unified Parkinson’s Disease Rating Scale; VIM = ventralis intermedius nucleus.
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  • 1

    Alesch F, , Pinter MM, , Helscher RJ, , Fertl L, , Benabid AL, & Koos WT: Stimulation of the ventral intermediate thalamic nucleus in tremor dominated Parkinson’s disease and essential tremor. Acta Neurochir (Wien) 136:7581, 1995

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    • Search Google Scholar
    • Export Citation
  • 2

    Benabid AL, , Pollak P, , Seigneuret E, , Hoffmann D, , Gay E, & Perret J: Chronic VIM thalamic stimulation in Parkinson’s disease, essential tremor and extra-pyramidal dyskinesias. Acta Neurochir Suppl 58:3944, 1993

    • Search Google Scholar
    • Export Citation
  • 3

    Fahn S, & Elton RL, Members of the UPDRS Development Committee: Unified Parkinson’s Disease Rating Scale. Fahn S, , Marsden CD, & Goldstein M, et al.: Recent Developments in Parkinson’s Disease, ed 2 New York, Macmillan, 1987. Vol 2:153163

    • Search Google Scholar
    • Export Citation
  • 4

    Fahn S, , Tolosa E, & Marin C, Clinical Rating Scale for Tremor. Jankovic J, & Tolosa E: Parkinson’s Disease and Movement Disorders Philadelphia, Williams & Wilkins, 1988. 225234

    • Search Google Scholar
    • Export Citation
  • 5

    Koller W, , Pahwa R, , Busenbark K, , Hubble J, , Wilkinson S, & Lang A, et al.: High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol 42:292299, 1997

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    • Search Google Scholar
    • Export Citation
  • 6

    Koller WC, , Lyons KE, , Wilkinson SB, , Troster AI, & Pahwa R: Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor. Mov Disord 16:464468, 2001

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    • Search Google Scholar
    • Export Citation
  • 7

    Limousin P, , Speelman JD, , Gielen F, & Janssens M: Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 66:289296, 1997

    • Search Google Scholar
    • Export Citation
  • 8

    Obwegeser AA, , Uitti RJ, , Turk MF, , Strongosky AJ, & Wharen RE: Thalamic stimulation for the treatment of midline tremors in essential tremor patients. Neurology 54:23422344, 2000

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    • Search Google Scholar
    • Export Citation
  • 9

    Ondo W, , Jankovic J, , Schwartz K, , Almaguer M, & Simpson RK: Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson’s disease tremor. Neurology 51:10631069, 1998

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    • Search Google Scholar
    • Export Citation
  • 10

    Rehncrona S, , Johnels B, , Widner H, , Tornqvist AL, , Hariz M, & Sydow O: Long-term efficacy of thalamic deep brain stimulation for tremor: double-blind assessments. Mov Disord 18:163170, 2003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Sydow O, , Thobois S, , Alesch F, & Speelman JD: Multicentre European study of thalamic stimulation in essential tremor: a six year follow up. J Neurol Neurosurg Psychiatry 74:13871391, 2003

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    • Search Google Scholar
    • Export Citation

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