Effect of deep brain simulation on arm, leg, and chin tremor in Parkinson disease

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OBJECTIVE

The efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in the treatment of Parkinson disease (PD)–related tremor has been well established. However, the relative impact on arm, leg, and chin tremor has been less clearly elucidated. The authors evaluated the distribution of tremors in a PD cohort undergoing STN DBS and sought to evaluate the differential impact of DBS as a function of tremor location.

METHODS

A retrospective study of patients with PD with tremor who underwent DBS surgery between 2012 and 2016 was performed to evaluate the impact of STN stimulation on overall and regional tremor scores.

RESULTS

Across 66 patients the authors found an average of 78% overall reduction in tremor after 6 months. In this cohort, the authors found that tremor reduction was somewhat better for arm than for leg tremors, especially in instances of higher preoperative tremor (84% vs 71% reduction, respectively, for initial tremor scores ≥ 2). No significant difference in response was found between patients with medication-responsive versus medication-nonresponsive tremors.

CONCLUSIONS

The authors found that although DBS improved tremor in all regions, the improvement was not uniform between chin, arm, and leg—even within the same patient. The reasons behind these differing responses are speculative but suggest that STN DBS may more reliably reduce arm tremors than leg tremors.

ABBREVIATIONS DBS = deep brain stimulation; PD = Parkinson disease; STN = subthalamic nucleus; UPDRS = Unified Parkinson’s Disease Rating Scale.
Article Information

Contributor Notes

Correspondence Michael Pourfar: New York University Langone Medical Center, New York, NY. michael.pourfar@nyumc.org.INCLUDE WHEN CITING Published online December 7, 2018; DOI: 10.3171/2018.7.JNS18784.Disclosures Dr. Pourfar has received teaching honoraria (Medtronic, Inc., Teva Pharmaceuticals, US World Meds); consultation compensation (Abbott, Inc., Lundbeck Pharmaceuticals); and grant support (Boston Scientific, Inc.). Dr. Mogilner has received consultation compensation (Medtronic, Inc., Alpha-Omega Engineering, Abbott, Inc.) and grant support (Boston Scientific, Inc., Medtronic, Inc., St. Jude Medical, Inc.).
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