Long-term results of thalamic deep brain stimulation for essential tremor

Clinical article

Kai Zhang Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; and

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Sanjay Bhatia Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

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Michael Y. Oh Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

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David Cohen Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

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Cindy Angle Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

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Donald Whiting Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

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Object

Deep brain stimulation (DBS) of the ventral intermediate nucleus of the thalamus (VIM) has proven to be efficacious in the treatment of essential tremor (ET). The authors report on long-term follow-up of a series of patients treated at 1 institution by 1 neurosurgeon.

Methods

Thirty-four patients with ET received unilateral or bilateral VIM DBS. The tremor and handwriting components of the Fahn-Tolosa-Marin clinical tremor rating scale were assessed pre- and postoperatively. Visual analog scale scores for overall patient satisfaction and tremor control were recorded. Stimulation parameters at different intervals after surgery were also recorded.

Results

The average follow-up period was 56.9 months. The average tremor score improved from 3.27 preoperatively to 0.64 postoperatively (on stimulation; p < 0.001) and the average handwriting score improved from 2.94 to 0.89 (p < 0.001). The average visual analog scale score for overall satisfaction was 8.12 and for tremor control was 1.43. Overall, there was an 80.4% improvement in tremor and 69.7% improvement in handwriting. In 12 patients both tremor and handwriting scores were compared between 57.3 months and 90.7 months after surgery and no significant changes were discovered. Comparison of stimulation parameters at onset and at 1–3, 3–5, 5–7, and > 7 years after surgery showed significant differences, with a gradual increase in stimulation parameters within 5 years after surgery. The overall hardware-related complication rate was 23.5%.

Conclusions

Deep brain stimulation of the VIM is an efficient and safe treatment for ET. Tremor and handwriting improvements in long-term follow-up are stable. The patients' perception of their outcome is quite good. However, tolerance may develop in some patients requiring changes in stimulation parameters.

Abbreviations used in this paper:

DBS = deep brain stimulation; ET = essential tremor; TRS = tremor rating scale; VAS = visual analog scale; VIM = ventral intermediate nucleus of the thalamus.
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