Thalamic deep brain stimulation for orthostatic tremor: A multicenter international registry
Merola A (1), Fasano A (2,3), Hassan A (4), Ostrem JL (5), Contarino MF (6,7,8), Lyons M (9), Krauss JK (10), Wolf ME (11), Klassen BT (4), van Rootselaar AF (6), Regidor I (12), Duker AP (1), Ondo W (13), Guridi J (14), Volkmann J (15), Shukla AW (16), Mandybur GT (17), Okun MS (16), Witt K (18,19), Starr PA (20), Deuschl G (18), Espay AJ (1).
(1) Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.
(2) Division of Neurology, Movement disorders center, University of Toronto Canada Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
(3) Krembil Research Institute, Toronto, Ontario, Canada.
(4) Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
(5) UCSF Movement Disorders and Neuromodulation Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA.
(6) Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
(7) Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
(8) Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands.
(9) Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, USA.
(10) Department of Neurosurgery, Medical School Hannover, MHH, Hannover, Germany.
(11) Department of Neurology, Universitaetsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
(12) Functional Neurosurgery Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain.
(13) Methodist Neurological Institute, Houston, Texas, USA.
(14) Neurosurgical Department, Clinica Universidad de Navarra, Navarra, Spain.
(15) Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
(16) Department of Neurology, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, USA.
(17) Department of Neurosurgery, University of Cincinnati College of Medicine. Mayfield Clinic- Neurosurgeon, Cincinnati, Ohio, USA.
(18) Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts University, Kiel, Germany.
19 Dept. of Neurology, School of Medicine and Health Sciences - European Medical School, University Oldenburg, Oldenburg, Germany.
20 UCSF Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
We report the accumulated experience with ventral intermediate nucleus deep brain stimulation for medically refractory orthostatic tremor.
Data from 17 patients were reviewed, comparing presurgical, short-term (0-48 months), and long-term (≥48 months) follow-up. The primary end point was the composite activities of daily living/instrumental activities of daily living score. Secondary end points included latency of symptoms on standing and treatment-related complications.
There was a 21.6% improvement (P = 0.004) in the composite activities of daily living/instrumental activities of daily living score, which gradually attenuated (12.5%) in the subgroup of patients with an additional long-term follow-up (8 of 17). The latency of symptoms on standing significantly improved, both in the short-term (P = 0.001) and in the long-term (P = 0.018). Three patients obtained no/minimal benefit from the procedure.
Deep brain stimulation of the ventral intermediate nucleus was, in general, safe and well tolerated, yielding sustained benefit in selected patients with medically refractory orthostatic tremor. © 2017 International Parkinson and Movement Disorder Society.
CITATION Mov Disord. 2017 Jun 20. doi: 10.1002/mds.27082