“Asleep” deep brain stimulation for essential tremor

Tsinsue Chen Divisions of Neurological Surgery and

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Zaman Mirzadeh Divisions of Neurological Surgery and

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Kristina Chapple Divisions of Neurological Surgery and

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Margaret Lambert Divisions of Neurological Surgery and

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Rohit Dhall Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona

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Francisco A. Ponce Divisions of Neurological Surgery and

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OBJECT

Deep brain stimulation (DBS) performed under general anesthesia (“asleep” DBS) has not been previously reported for essential tremor. This is in part due to the inability to visualize the target (the ventral intermediate nucleus [VIM]) on MRI. The authors evaluate the efficacy of this asleep technique in treating essential tremor by indirect VIM targeting.

METHODS

The authors retrospectively reviewed consecutive cases of initial DBS for essential tremor performed by a single surgeon. DBS was performed with patients awake (n = 40, intraoperative test stimulation without microelectrode recording) or asleep (n = 17, under general anesthesia). Targeting proceeded with standardized anatomical coordinates on preoperative MRI. Intraoperative CT was used for stereotactic registration and lead position confirmation. Functional outcomes were evaluated with pre- and postoperative Bain and Findley Tremor Activities of Daily Living scores.

RESULTS

A total of 29 leads were placed in asleep patients, and 60 were placed in awake patients. Bain and Findley Tremor Activities of Daily Living Questionnaire scores were not significantly different preoperatively for awake versus asleep cohorts (p = 0.2). The percentage of postoperative improvement was not significantly different between asleep (48.6%) and awake (45.5%) cohorts (p = 0.35). Euclidean error (mm) was higher for awake versus asleep patients (1.7 ± 0.8 vs 1.2 ± 0.4, p = 0.01), and radial error (mm) trended higherfor awake versus asleep patients (1.3 ± 0.8 vs 0.9 ± 0.5, p = 0.06). There were no perioperative complications.

CONCLUSIONS

In the authors’ initial experience, asleep VIM DBS for essential tremor without intraoperative test stimulation can be performed safely and effectively.

ABBREVIATIONS

AC-PC = anterior commissural-posterior commissural; ADL = activities of daily living; DBS = deep brain stimulation; HOB = head of bed; IC = intercommissural; iCT = intraoperative CT; VIM = ventral intermediate nucleus.
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