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J Neurol Neurosurg Psychiatry 2005;76:684-690 doi:10.1136/jnnp.2004.041434
  • Paper

Bilateral thalamic deep brain stimulation: midline tremor control

  1. J D Putzke1,
  2. R J Uitti1,
  3. A A Obwegeser2,*,
  4. Z K Wszolek1,
  5. R E Wharen2
  1. 1Department of Neurology, Mayo Clinic Jacksonville, Florida, USA
  2. 2Department of Neurosurgery, Mayo Clinic Jacksonville
  1. Correspondence to:
 Dr R J Uitti
 Department of Neurology, Davis Bldg E-8, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA; uittimayo.edu
  • Received 12 March 2004
  • Accepted 21 August 2004
  • Revised 26 July 2004

Abstract

Objectives: To determine the efficacy of bilateral deep brain stimulation (DBS) for management of midline tremor (head, voice, tongue, trunk) in patients with essential tremor.

Design: Prospective assessment of tremor at baseline (presurgical), and postoperatively at 1, 3, and 12 months, and annually thereafter.

Methods: A clinical series of 22 individuals undergoing staged, bilateral DBS for treatment of essential tremor. The tremor rating scale was the primary outcome measure.

Results: Midline tremor showed significant improvement with stimulation “on” at nearly every postoperative interval when compared with stimulation “off” and with baseline tremor. Bilateral stimulation was associated with a significant incremental improvement in midline tremor control compared with unilateral stimulation: average “stimulation on” percentage change in midline tremor from the unilateral to bilateral period was 81%. Head and voice tremor showed the most consistent improvement. Among those requiring a change in stimulation parameters because of side effects, dysarthria, disequilibrium, motor disturbances, and paraesthesiae were the most common. Dysarthria was more common with bilateral (n = 6; 27%) than with unilateral (n = 0) stimulation. Stimulation parameters remained largely unchanged after the first three months. Nine of 44 leads placed (20%) required subsequent repositioning or replacement.

Conclusions: Unilateral thalamic stimulation significantly improves midline tremor, and subsequent bilateral thalamic stimulation offers an additional incremental improvement in midline tremor control.

Footnotes

  • ↵* Also at Department of Neurosurgery, University Innsbruck, Austria

  • Competing interests: none declared

Responses to this article

  • Laterality of motor control in deep brain stimulation
    • iraj derakhshan, md
    J Neurol Neurosurg Psychiatry published online March 6, 2006

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