scholarly journals “Asleep” deep brain stimulation for essential tremor

2016 ◽  
Vol 124 (6) ◽  
pp. 1842-1849 ◽  
Author(s):  
Tsinsue Chen ◽  
Zaman Mirzadeh ◽  
Kristina Chapple ◽  
Margaret Lambert ◽  
Rohit Dhall ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Activities Of Daily Living ◽  
General Anesthesia ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Daily Living ◽  
Perioperative Complications ◽  
Test Stimulation ◽  
Intraoperative Test ◽  
Deep Brain

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.

scholarly journals Thalamic Deep Brain Stimulation Essential Tremor: Recommendations Long-Term Outcome Analysis

2004 ◽  
Vol 31 (3) ◽  
pp. 333-342 ◽  
Author(s):  
J.D. Putzke ◽  
R.E. Wharen, Jr. ◽  
A.A. Obwegeser ◽  
Z.K. Wszolek ◽  
J.A. Lucas ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Activities Of Daily Living ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Daily Living ◽  
Objective Measures ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Deep Brain

Objectives:Determine the efficacy of thalamic deep brain stimulation (DBS) for tremor control among individuals with essential tremor (ET).Methods:A clinical series of 52 consecutive individuals undergoing placement of a DBS system for treatment of ET completed an unblinded battery of subjective and objective measures at postoperative intervals of one, three, and 12 months, and annually thereafter up to three years. The assessment battery included measures of tremor and activities of daily living.Results:Both subjective and objective measures showed that stimulation was associated with significant improvement at nearly every postoperative interval as compared to pre-operative and stimulation 'off' ratings of activities of daily living functioning, midline tremor, contralateral upper extremity tremor, and contralateral lower extremity tremor. Ipsilateral tremor showed some improvement with stimulation, but only within the first three months. Trend analysis showed stable tremor control. Stimulation settings remained largely unchanged after the first three months. Dysarthria was more common among those with bilateral stimulation. A range of missing data estimation methods were performed, and subsequent analyses corroborated the main findings of the study.Conclusion:Thalamic DBS is generally a well-tolerated and effective treatment for ET. Methodological and analytical recommendations are provided for the evaluation of long-term outcome.

scholarly journals Difficulties in activities of daily living are associated with stigma in patients with Parkinson’s disease who are candidates for deep brain stimulation

2020 ◽  
Vol 42 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Antônio G. da Silva ◽  
Vanessa P. Leal ◽  
Paulo R. da Silva ◽  
Fernando C. Freitas ◽  
Marcelo N. Linhares ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Activities Of Daily Living ◽  
Brain Stimulation ◽  
Daily Living ◽  
Deep Brain

scholarly journals Intraoperative test stimulation versus stereotactic accuracy as a surgical end point: a comparison of essential tremor outcomes after ventral intermediate nucleus deep brain stimulation

2018 ◽  
Vol 129 (2) ◽  
pp. 290-298 ◽  
Author(s):  
Tsinsue Chen ◽  
Zaman Mirzadeh ◽  
Kristina M. Chapple ◽  
Margaret Lambert ◽  
Virgilio G. H. Evidente ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Conscious Sedation ◽  
Test Stimulation ◽  
Ventral Intermediate Nucleus ◽  
The Mean ◽  
Intraoperative Test ◽  
Deep Brain

OBJECTIVEVentral intermediate nucleus deep brain stimulation (DBS) for essential tremor is traditionally performed with intraoperative test stimulation and conscious sedation, without general anesthesia (GA). Recently, the authors reported retrospective data on 17 patients undergoing DBS after induction of GA with standardized anatomical coordinates on T1-weighted MRI sequences used for indirect targeting. Here, they compare prospectively collected data from essential tremor patients undergoing DBS both with GA and without GA (non-GA).METHODSClinical outcomes were prospectively collected at baseline and 3-month follow-up for patients undergoing DBS surgery performed by a single surgeon. Stereotactic, euclidean, and radial errors of lead placement were calculated. Functional (activities of daily living), quality of life (Quality of Life in Essential Tremor [QUEST] questionnaire), and tremor severity outcomes were compared between groups.RESULTSFifty-six patients underwent surgery: 16 without GA (24 electrodes) and 40 with GA (66 electrodes). The mean baseline functional scores and QUEST summary indices were not different between groups (p = 0.91 and p = 0.59, respectively). Non-GA and GA groups did not differ significantly regarding mean postoperative percentages of functional improvement (non-GA, 47.9% vs GA, 48.1%; p = 0.96) or QUEST summary indices (non-GA, 79.9% vs GA, 74.8%; p = 0.50). Accuracy was comparable between groups (mean radial error 0.9 ± 0.3 mm for non-GA and 0.9 ± 0.4 mm for GA patients) (p = 0.75). The mean euclidean error was also similar between groups (non-GA, 1.1 ± 0.6 mm vs GA, 1.2 ± 0.5 mm; p = 0.92). No patient had an intraoperative complication, and the number of postoperative complications was not different between groups (non-GA, n = 1 vs GA, n = 10; p = 0.16).CONCLUSIONSDBS performed with the patient under GA to treat essential tremor is as safe and effective as traditional DBS surgery with intraoperative test stimulation while the patient is under conscious sedation without GA.

scholarly journals Selecting the Most Effective DBS Contact in Essential Tremor Patients Based on Individual Tractography

2020 ◽  
Vol 10 (12) ◽  
pp. 1015
Author(s):  
Jan Niklas Petry-Schmelzer ◽  
Till A. Dembek ◽  
Julia K. Steffen ◽  
Hannah Jergas ◽  
Haidar S. Dafsari ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Diffusion Tensor ◽  
Clinical Effectiveness ◽  
Clinical Testing ◽  
Linear Mixed Effects ◽  
Test Stimulation ◽  
The Individual ◽  
Deep Brain

Postoperative choice of the most effective deep brain stimulation (DBS) contact in patients with essential tremor (ET) so far relies on lengthy clinical testing. Previous studies showed that the postoperative effectiveness of DBS contacts depends on the distance to the dentatorubrothalamic tract (DRTT). Here, we investigated whether the most effective DBS contact could be determined from calculating stimulation overlap with the individual DRTT. Seven ET patients with bilateral thalamic deep brain stimulation were included retrospectively. Tremor control was assessed for each contact during test stimulation with 2mA. Individual DRTTs were identified from diffusion tensor imaging and contacts were ranked by their stimulation overlap with the respective DRTT in relation to their clinical effectiveness. A linear mixed-effects model was calculated to determine the influence of the DRTT overlap on tremor control. In 92.9% of investigated DBS leads, the contact with the best clinical effect was the contact with the highest or second-highest DRTT-overlap. At the group level, the DRTT-overlap explained 26.7% of the variance in the clinical outcomes (p < 0.001). Our data suggest that the overlap with the DRTT based on individual tractography may serve as a marker to determine the most effective DBS contact in ET patients and reduce burdensome clinical testing in the future.

Concepts and Methods in Chronic Thalamic Stimulation for Treatment of Tremor: Technique and Application

Neurosurgery ◽  
2001 ◽  
Vol 48 (3) ◽  
pp. 535-543 ◽  
Author(s):  
Joachim K. Krauss ◽  
Richard K. Simpson ◽  
William G. Ondo ◽  
Thomas Pohle ◽  
Jean-Marc Burgunder ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Side Effects ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Surgical Techniques ◽  
Symptomatic Improvement ◽  
Test Stimulation ◽  
Deep Brain

Abstract OBJECTIVE To rationalize the technique and reduce the costs associated with chronic deep brain stimulation of the thalamus for treatment of refractory tremor. METHODS The efficacy and safety of a modification in surgical techniques was prospectively assessed in 94 patients with tremor. Bilateral electrodes were implanted in 29 patients, and 65 patients received unilateral implants. Forty-five patients had Parkinson's disease tremor, 42 patients had essential tremor, and 7 patients had kinetic tremors of different causes. In all instances, intraoperative stimulations to analyze the thresholds of intrinsic and extrinsic responses were performed directly with the implanted leads. The electrodes were repositioned until satisfactory results were achieved. The pulse generators were implanted directly after the first step in the same operative session. Patients were not subjected to interoperative test stimulation trials. RESULTS Postoperative improvement of tremor at a mean follow-up of 11.9 months was rated as excellent in 47 patients (50%), marked in 37 patients (39%), moderate in 8 patients (9%), and minor in 2 patients (2%). There was no persistent morbidity related to surgery. In patients with Parkinson's disease, the symptomatic improvement of tremor was rated as excellent in 51% of patients, marked in 36%, moderate in 11%, and minor in 2%. In patients with essential tremor, symptomatic outcome was classified as excellent in 57% of patients, marked in 36%, moderate in 5%, and minor in 2%. Six of the seven patients with kinetic tremor achieved marked symptomatic improvement, and one patient experienced moderate improvement. Forty patients experienced stimulation-related side effects. Side effects were mild in general, and they were reversible with a change in electrical parameters. They occurred more frequently in patients who had bilateral stimulation. CONCLUSION Excellent to marked improvement of tremor is achieved in the majority of patients with physiological target determination via implanted leads in thalamic deep brain stimulation. Interoperative test stimulation trials are unnecessary. Modifications in technique may help to reduce the costs of the related hospital stay.

scholarly journals Deep brain stimulation for Parkinson’s disease: meta-analysis of results of randomized trials at varying lengths of follow-up

2018 ◽  
Vol 128 (4) ◽  
pp. 1199-1213 ◽  
Author(s):  
Alireza Mansouri ◽  
Shervin Taslimi ◽  
Jetan H. Badhiwala ◽  
Christopher D. Witiw ◽  
Farshad Nassiri ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Activities Of Daily Living ◽  
Brain Stimulation ◽  
Daily Living ◽  
Meta Analysis ◽  
Stn Dbs ◽  
Deep Brain

OBJECTIVEDeep brain stimulation (DBS) is effective in the management of patients with advanced Parkinson’s disease (PD). While both the globus pallidus pars interna (GPi) and the subthalamic nucleus (STN) are accepted targets, their relative efficacy in randomized controlled trials (RCTs) has not been established beyond 12 months. The objective of this study was to conduct a meta-analysis of RCTs to compare outcomes among adults with PD undergoing DBS of GPi or STN at various time points, including 36 months of follow-up.METHODSThe MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases were searched. Registries for clinical trials, selected conference proceedings, and the table of contents for selected journals were also searched. Screens were conducted independently and in duplicate. Among the 623 studies initially identified (615 through database search, 7 through manual review of bibliographies, and 1 through a repeat screen of literature prior to submission), 19 underwent full-text review; 13 of these were included in the quantitative meta-analysis. Data were extracted independently and in duplicate. The Cochrane Collaboration tool was used to assess the risk of bias. The GRADE evidence profile tool was used to assess the quality of the evidence. Motor scores, medication dosage reduction, activities of daily living, depression, dyskinesias, and adverse events were compared. The influence of disease duration (a priori) and the proportion of male patients within a study (post hoc) were explored as potential subgroups.RESULTSThirteen studies (6 original cohorts) were identified. No difference in motor scores or activities of daily living was identified at 36 months. Medications were significantly reduced with STN stimulation (5 studies, weighted mean difference [WMD] −365.46, 95% CI −599.48 to −131.44, p = 0.002). Beck Depression Inventory scores were significantly better with GPi stimulation (3 studies; WMD 2.53, 95% CI 0.99–4.06 p = 0.001). The motor benefits of GPi and STN DBS for PD are similar.CONCLUSIONSThe motor benefits achieved with GPi and STN DBS for PD are similar. DBS of STN allows for a greater reduction of medication, but not as significant an advantage as DBS of GPi with respect to mood. This difference is sustained at 36 months. Further long-term studies are necessary.

scholarly journals Use of quantitative tremor evaluation to enhance target selection during deep brain stimulation surgery for essential tremor

2015 ◽  
Vol 1 (1) ◽  
pp. 488-492 ◽  
Author(s):  
A. Shah ◽  
J. Coste ◽  
JJ. Lemaire ◽  
E. Schkommodau ◽  
S. Hemm-Ode
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Quantitative Methods ◽  
Evaluation Method ◽  
Target Selection ◽  
Thalamic Nuclei ◽  
Visual Evaluation ◽  
Test Stimulation ◽  
Deep Brain

AbstractDeep brain stimulation (DBS), an effective surgical treatment for Essential Tremor (ET), requires test stimulations in the thalamus to find the optimum site for permanent electrode implantation. During these test stimulations, the changes in tremor are only visually evaluated. This, along with other parameters, increases the subjectivity when comparing the efficacy of different thalamic nuclei. We developed a method to quantitatively evaluate tremor during the test stimulations of DBS surgery and applied to 6 ET patients undergoing this treatment. From the quantitative data collected, we identified effective stimulation amplitudes for every test stimulation position and compared it with the ones identified visually during the surgery. We also classified the data based on the thalamic nuclei in which the center of the stimulating contact was present during test stimulations. Results indicate that, to achieve the same reduction in tremor, on average, the stimulation amplitude identified by our method was 0.6 mA lower than those identified by visual evaluation. The comparison of the different thalamic nuclei showed that stimulations in the Ventro-oral and the Intermediolateral nuclei of the thalamus result in higher reduction in tremor for similar stimulation amplitudes as the frequently targeted Ventrointermediate nucleus. We conclude that our quantitative tremor evaluation method is more sensitive than the widely used visual evaluation. Using such quantitative methods will aid in identifying the optimum target structure for patients undergoing DBS.

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