Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor
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Abstract
Objective To assess longitudinal tremor outcomes with ventral intermediate nucleus deep brain stimulation (VIM DBS) in patients with dystonic tremor (DT) and to compare with DBS outcomes in essential tremor (ET).
Methods We retrospectively investigated VIM DBS outcomes for 163 patients followed at our center diagnosed with either DT or ET. The Fahn-Tolosa-Marin tremor rating scale (TRS) was used to assess change in tremor and activities of daily living (ADL) at 6 months, 1 year, 2–3 years, 4–5 years, and ≥6 years after surgery.
Results Twenty-six patients with DT and 97 patients with ET were analyzed. Compared to preoperative baseline, there were significant improvements in TRS motor up to 4–5 years (52.2%; p = 0.032) but this did not reach statistical significance at ≥6 years (46.0%, p = 0.063) in DT, which was comparable to the outcomes in ET. While the improvements in the upper extremity tremor, head tremor, and axial tremor were also comparable between DT and ET throughout the follow-up, the ADL improvements in DT were lost at 2–3 years follow-up.
Conclusion Overall, tremor control with VIM DBS in DT and ET was comparable and remained sustained at long term likely related to intervention at the final common node in the pathologic tremor network. However, the long-term ADL improvements in DT were not sustained, possibly due to inadequate control of concomitant dystonia symptoms. These findings from a large cohort of DT indicate that VIM targeting is reasonable if the tremor is considerably more disabling than the dystonic features.
Classification of evidence This study provides Class IV evidence that VIM DBS improves tremor in patients with DT or ET.
Glossary
- ADL=
- activities of daily living;
- AE=
- adverse event;
- DBS=
- deep brain stimulation;
- DT=
- dystonic tremor;
- ET=
- essential tremor;
- GPi=
- globus pallidus interna;
- PD=
- Parkinson disease;
- STN=
- subthalamic nucleus;
- TRS=
- Fahn-Tolosa-Marin tremor rating scale;
- UE=
- upper extremities;
- VIM=
- ventral intermediate nucleus
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Class of Evidence: NPub.org/coe
CME Course: NPub.org/cmelist
- Received April 21, 2019.
- Accepted in final form September 10, 2019.
- © 2020 American Academy of Neurology
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