Deep Brain Stimulation (DBS) Is a safe and Effective Treatment for Medically Refractory Essential Tremor
Abstract & Commentary
By Matthew E. Fink, MD Dr. Fink is Vice Chairman, Professor of Clinical Neurology, Weill Medical College, Chief, Division of Stroke and Critical Care Neurology, New York-Presbyterian Hospital. Dr. Fink reports no consultant, stockholder, speaker's bureau, research, or other relationship related to this field of study.
Synopsis: In a consecutive case series of 18 patients with severe essential tremor who underwent implantation of bilateral thalamic DBS electrodes, high-frequency stimulation resulted in significant, long-term improvement in their quality of life.
Source: Lee JYK, et al. Thalamic Deep Brain Stimulation for Management of Essential Tremor. J Neurosurgery. 2005; 103:400-403.
Essential tremor (ET) is the most common movement disorder, and may have a progressive course. A small percentage of patients with ET become functionally impaired because of illegible handwriting, difficulties while eating and drinking, and tremulous speech. The standard medications, propranolol and primidone, may help, but have limited efficacy and significant side-effects. Stereotactic thalamotomy is effective in reducing tremor from both Parkinson's disease and ET, but this destructive procedure has significant morbidity and mortality, especially if performed bilaterally.
Lee and colleagues report a case series from a single center performed by a single surgeon, using a consistent protocol. Eighteen patients (mean age, 60 years) with severe and debilitating tremor underwent bilateral stereotactic implantation of electrodes in the ventralis intermedius nucleus of the thalamus. Electrode placement was performed with the patient awake, and correct placement was confirmed by documenting tremor cessation during a test stimulation in the operating room. All patients were discharged to home the next day, and response to stimulation was measured with the Fahn-Tolosa-Marin tremor score and handwriting score. Preoperative mean tremor score was 3.3 ± 0.5, and postoperative mean score with the DBS system activated was 0.8 ± 0.4; preoperative mean handwriting score was 2.8 ± 0.9, and postoperative mean handwriting score was 1 ± 0.6. Six patients had minor complications from the implanted hardware, but still continued to enjoy benefits from DBS.
The median follow-up after surgery was 27 months. Eleven patients were followed for more than 2 years, and 8 patients were followed for longer than 4 years. Although the DBS stimulation parameters were altered over time, all of the patients continued to show benefits from DBS.
In a consecutive case series of 18 patients with severe essential tremor who underwent implantation of bilateral thalamic DBS electrodes, high-frequency stimulation resulted in significant, long-term improvement in their quality of life.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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