scholarly journals Deep brain stimulation of the ventralis intermedius nucleus for the treatment of essential tremor

2017 ◽  
Vol 42 (videosuppl2) ◽  
pp. V3
Author(s):  
Alexander G. Chartrain ◽  
Ahmed J. Awad ◽  
Jonathan J. Rasouli ◽  
Robert J. Rothrock ◽  
Brian H. Kopell
Keyword(s):  
Deep Brain Stimulation ◽  
Physical Examination ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Optimal Trajectory ◽  
Lesion Effect ◽  
Lead Placement ◽  
History Of ◽  
Deep Brain ◽  
Stimulation Of

A 59-year-old woman with a 30-year history of essential tremor refractory to medical therapy underwent staged deep brain stimulation of the ventralis intermedius nucleus of the thalamus (VIM). Left-sided lead placement was performed first. Once in the operating room, microelectrode recording (MER) was performed to confirm the appropriate trajectory and identify the VIM border with the ventralis caudalis nucleus. MER was repeated after repositioning 2 mm anteriorly to reduce the likelihood of stimulation-induced paresthesias. Physical examination prior to permanent lead placement demonstrated micro-lesion effect, suggesting optimal trajectory. After implantation of the permanent lead, physical examination showed excellent results.The video can be found here: https://youtu.be/nn3KRdmRCZ4.

Efficacy of unilateral deep brain stimulation of the thalamic ventralis intermedius nucleus in a patient with bipolar disorder associated with Klinefelter syndrome and essential tremor

2000 ◽  
Vol 93 (1) ◽  
pp. 127-128 ◽  
Author(s):  
Albert E. Telfeian ◽  
John A. Boockvar ◽  
Tanya Simuni ◽  
Jurg Jaggi ◽  
Brett Skolnick ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Genetic Basis ◽  
Klinefelter Syndrome ◽  
Content Type ◽  
History Of ◽  
Deep Brain ◽  
Stimulation Of

✓ Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) is a safe and effective treatment for essential tremor. Bipolar disorder and essential tremor had each been reported to occur in association with Klinefelter syndrome but the three diseases have been reported to occur together in only one patient. The genetic basis and natural history of these disorders are not completely understood and may be related rather than coincidental. The authors report on a 23-year-old man with Klinefelter syndrome (47,XXY) and bipolar disorder who was treated successfully with unilateral DBS of the thalamic Vim for essential tremor.

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

2010 ◽  
Vol 112 (3) ◽  
pp. 491-496 ◽  
Author(s):  
Takashi Morishita ◽  
Kelly D. Foote ◽  
Samuel S. Wu ◽  
Charles E. Jacobson ◽  
Ramon L. Rodriguez ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Operating Room ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Lead Placement ◽  
Ventral Intermediate Nucleus ◽  
The Impact ◽  
Over Time ◽  
Deep Brain

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.

scholarly journals An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Ha Son Nguyen ◽  
Harvey Woehlck ◽  
Peter Pahapill
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Unusual Case ◽  
Case Presentation ◽  
Volume State ◽  
Lead Placement ◽  
History Of ◽  
Symptomatic Bradycardia ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery.Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully.Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.

Operative Technique and Workflow of Deep Brain Stimulation Surgery With Pre-existing Cochlear Implants

2019 ◽  
Vol 19 (2) ◽  
pp. 143-149
Author(s):  
Erik Bolier ◽  
Jessica A Karl ◽  
R Mark Wiet ◽  
Alireza Borghei ◽  
Leo Verhagen Metman ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cochlear Implants ◽  
Brain Stimulation ◽  
Operative Technique ◽  
Case Reports ◽  
Time Frame ◽  
Lead Placement ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Deep Brain

Abstract Background Deep brain stimulation (DBS) surgery in patients with pre-existing cochlear implants (CIs) poses various challenges. We previously reported successful magnetic resonance imaging (MRI)-based, microelectrode recording (MER)-guided subthalamic DBS surgery in a patient with a pre-existing CI. Other case reports have described various DBS procedures in patients with pre-existing CIs using different techniques, leading to varying issues to address. A standardized operative technique and workflow for DBS surgery in the setting of pre-existing CIs is much needed. Objective To provide a standardized operative technique and workflow for DBS lead placement in the setting of pre-existing CIs. Methods Our operative technique is MRI-based and MER-guided, following a workflow involving coordination with a neurotology team to remove and re-implant the internal magnets of the CIs in order to safely perform DBS lead placement, altogether within a 24-h time frame. Intraoperative nonverbal communication with the patient is easily possible using a computer monitor. Results A 65-yr old woman with a 10-yr history of craniocervical dystonia and pre-existing bilateral CIs underwent successful bilateral pallidal DBS surgery at our institution. No merging errors or difficulties in targeting globus pallidus internus were experienced. Also, inactivated CIs do not interfere with MER nor with stimulation, and intraoperative communication with the patient using a computer monitor proved feasible and satisfactory. Conclusion DBS procedures are safe and feasible in patients with pre-existing CIs if precautions are taken following our workflow.

Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor

2001 ◽  
Vol 16 (3) ◽  
pp. 464-468 ◽  
Author(s):  
William C. Koller ◽  
Kelly E. Lyons ◽  
Steven B. Wilkinson ◽  
Alexander I. Troster ◽  
Rajesh Pahwa
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Safety And Efficacy ◽  
Deep Brain ◽  
Stimulation Of
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