Brain penetration effects of microelectrodes and deep brain stimulation leads in ventral intermediate nucleus stimulation for essential tremor

Clinical article

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  • 1 Departments of Neurology,
  • 2 Neurosurgery, and
  • 3 Applied Physiology and Kinesiology, Movement Disorders Center, University of Florida, McKnight Brain Institute, Gainesville;
  • 4 Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, Florida; and
  • 5 Department of Neurology, Wake Forest University, Winston-Salem, North Carolina
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Object

Microelectrode recording (MER) and macrostimulation (test stimulation) are used to refine the optimal deep brain stimulation (DBS) lead placement within the operative setting. It is well known that there can be a microlesion effect with microelectrode trajectories and DBS insertion. The aim of this study was to determine the impact of intraoperative MER and lead placement on tremor severity in a cohort of patients with essential tremor.

Methods

Consecutive patients with essential tremor undergoing unilateral DBS (ventral intermediate nucleus stimulation) for medication-refractory tremor were evaluated. Tremor severity was measured at 5 time points utilizing a modified Tremor Rating Scale: 1) immediately before MER; 2) immediately after MER; 3) immediately after lead implantation; 4) 6 months after DBS implantation in the off-DBS condition; and 5) 6 months after implantation in the on-DBS condition. To investigate the impact of the MER and DBS lead placement, Wilcoxon signed-rank tests were applied to test changes in tremor severity scores over the surgical course. In addition, a generalized linear mixed model including factors that potentially influenced the impact of the microlesion was also used for analysis.

Results

Nineteen patients were evaluated. Improvement was noted in the total modified Tremor Rating Scale, postural, and action tremor scores (p < 0.05) as a result of MER and DBS lead placement. The improvements observed following lead placement were similar in magnitude to what was observed in the chronically programmed clinic setting parameters at 6 months after lead implantation. Improvement in tremor severity was maintained over time even in the off-DBS condition at 6 months, which was supportive of a prolonged microlesion effect. The number of macrostimulation passes, the number of MER passes, and disease duration were not related to the change in tremor severity score over time.

Conclusions

Immediate improvement in postural and intention tremors may result from MER and DBS lead placement in patients undergoing DBS for essential tremor. This improvement could be a predictor of successful DBS lead placement at 6 months. Clinicians rating patients in the operating room should be aware of these effects and should consider using rating scales before and after lead placement to take these effects into account when evaluating outcome in and out of the operating room.

Abbreviations used in this paper: DBS = deep brain stimulation; MER = microelectrode recording; mTRS = modified TRS; STN = subthalamic nucleus; TRS = Tremor Rating Scale; Vim = ventral intermediate nucleus.

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Contributor Notes

Address correspondence to: Takashi Morishita, M.D., Department of Neurology, McKnight Brain Institute, 100 South Newell Drive, Room L3-101, Gainesville, Florida 32610. email: takashi.morishita@neurology.ufl.edu.

Please include this information when citing this paper: published online August 7, 2009; DOI: 10.3171/2009.7.JNS09150.

  • 1

    Binder DK, , Rau GM, & Starr PA: Risk factors for hemorrhage during microelectrode-guided deep brain stimulator implantation for movement disorders. Neurosurgery 56:722732, 2005

    • Search Google Scholar
    • Export Citation
  • 2

    Counelis GJ, , Simuni T, , Forman MS, , Jaggi JL, , Trojanowski JQ, & Baltuch GH: Bilateral subthalamic nucleus deep brain stimulation for advanced PD: correlation of intraoperative MER and postoperative MRI with neuropathological findings. Mov Disord 18:10621065, 2003

    • Search Google Scholar
    • Export Citation
  • 3

    Deep Brain Stimulation for Parkinson's Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345:956963, 2001

    • Search Google Scholar
    • Export Citation
  • 4

    Deuschl G, , Herzog J, , Kleiner-Fisman G, , Kubu C, , Lozano AM, & Lyons KE, : Deep brain stimulation: postoperative issues. Mov Disord 21:14 Suppl S219S237, 2006

    • Search Google Scholar
    • Export Citation
  • 5

    Dormont D, , Cornu P, , Pidoux B, , Bonnet AM, , Biondi A, & Oppenheim C, : Chronic thalamic stimulation with threedimensional MR stereotactic guidance. AJNR Am J Neuroradiol 18:10931107, 1997

    • Search Google Scholar
    • Export Citation
  • 6

    Ellis TM, , Foote KD, , Fernandez HH, , Sudhyadhom A, , Rodriguez RL, & Zeilman P, : Reoperation for suboptimal outcomes after deep brain stimulation surgery. Neurosurgery 63:754761, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Hariz MI, & Fodstad H: Do microelectrode techniques increase accuracy or decrease risks in pallidotomy and deep brain stimulation? A critical review of the literature. Stereotact Funct Neurosurg 72:157169, 1999

    • Search Google Scholar
    • Export Citation
  • 8

    Henderson J, , Rodriguez M, , O'Sullivan D, , Pell M, , Fung V, & Benabid AL, : Partial lesion of thalamic ventral intermediate nucleus after chronic high-frequency stimulation. Mov Disord 19:709711, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Henderson JM, , Pell M, , O'Sullivan DJ, , McCusker EA, , Fung VS, & Hedges P, : Postmortem analysis of bilateral subthalamic electrode implants in Parkinson's disease. Mov Disord 17:133137, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Kondziolka D, & Lee JY: Long-lasting microthalamotomy effect after temporary placement of a thalamic stimulating electrode. Stereotact Funct Neurosurg 82:127130, 2004

    • Search Google Scholar
    • Export Citation
  • 11

    Koop MM, , Andrzejewski A, , Hill BC, , Heit G, & Bronte-Stewart HM: Improvement in a quantitative measure of bradykinesia after microelectrode recording in patients with Parkinson's disease during deep brain stimulation surgery. Mov Disord 21:673678, 2006

    • Search Google Scholar
    • Export Citation
  • 12

    Maltete D, , Derrey S, , Chastan N, , Debono B, , Gerardin E, & Freger P, : Microsubthalamotomy: an immediate predictor of long-term subthalamic stimulation efficacy in Parkinson disease. Mov Disord 23:10471050, 2008

    • Search Google Scholar
    • Export Citation
  • 13

    Mann JM, , Foote KD, , Garvan CW, , Fernandez HH, , Jacobson CE IV, & Rodriguez RL, : Brain penetration effects of microelectrodes and DBS leads in STN or GPi. J Neurol Neurosurg Psychiatry 80:794797, 2009

    • Search Google Scholar
    • Export Citation
  • 14

    Nielsen MS, , Bjarkam CR, , Sorensen JC, , Bojsen-Moller M, , Sunde NA, & Ostergaard K: Chronic subthalamic high-frequency deep brain stimulation in Parkinson's disease–a histopathological study. Eur J Neurol 14:132138, 2007

    • Search Google Scholar
    • Export Citation
  • 15

    Pollak P, , Krack P, , Fraix V, , Mendes A, , Moro E, & Chabardes S, : Intraoperative micro- and macrostimulation of the subthalamic nucleus in Parkinson's disease. Mov Disord 17:3 Suppl S155S161, 2002

    • Search Google Scholar
    • Export Citation
  • 16

    Tasker RR: Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol 49:145154, 1998

  • 17

    Tisch S, , Rothwell JC, , Bhatia KP, , Quinn N, , Zrinzo L, & Jahanshahi M, : Pallidal stimulation modifies after-effects of paired associative stimulation on motor cortex excitability in primary generalised dystonia. Exp Neurol 206:8085, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    Toda H, , Hamani C, , Fawcett AP, , Hutchison WD, & Lozano AM: The regulation of adult rodent hippocampal neurogenesis by deep brain stimulation. J Neurosurg 108:132138, 2008

    • Search Google Scholar
    • Export Citation

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