Multicentre European study of thalamic stimulation for parkinsonian tremor: a 6 year follow-up
- M I Hariz1,2,
- P Krack3,
- F Alesch4,
- L-E Augustinsson5,
- A Bosch6,
- R Ekberg7,
- F Johansson8,
- B Johnels9,
- B A Meyerson10,
- J-P N’Guyen11,
- M Pinter12,
- P Pollak3,
- F von Raison13,
- S Rehncrona14,
- J D Speelman15,
- O Sydow16,
- A-L Benabid17
- 1Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden
- 2Institute of Neurology, Queen Square, London, UK
- 3Department of Neurology, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France
- 4Department of Neurosurgery, Universitätsklinik, Vienna, Austria
- 5Department of Neurosurgery, Sahlgrenska University Hospital, Göteborg, Sweden
- 6Department of Neurosurgery, Academic Medical Centre, Amsterdam, The Netherlands
- 7Department of Neurology, University Hospital, Lund, Sweden
- 8Department of Neurology, University Hospital of Northern Sweden, Umeå, Sweden
- 9Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden
- 10Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- 11Department of Neurosurgery, CHU Henri-Mondor, Créteil, France
- 12Department of Neurology, Universitätsklinik, Vienna, Austria
- 13Department of Neurology, CHU Henri-Mondor, Créteil, France
- 14Department of Neurosurgery, University Hospital, Lund, Sweden
- 15Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
- 16Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- 17Department of Neurosurgery, CHU Grenoble, INSERM U318, Université Joseph Fourier, Grenoble, France
- Professor M Hariz, Institute of Neurology, Box 146, Queen Square, London WC1N 3BG, UK;
- Received 18 February 2007
- Revised 29 August 2007
- Accepted 17 September 2007
- Published Online First 26 September 2007
Aim: To evaluate the results of ventral intermediate (Vim) thalamic deep brain stimulation (DBS) in patients with tremor predominant Parkinson’s disease (PD) at 6 years post surgery.
Methods: This was a prolonged follow-up study of 38 patients from eight centres who participated in a multicentre study, the 1 year results of which have been published previously. Total scores as well as scores for individual items of the motor part and the disability part of the Unified Parkinson’s Disease Rating Scale were used for evaluation.
Results: Tremor was still effectively controlled by DBS and appendicular rigidity and akinesia remained stable compared with baseline. Axial scores (speech, gait and postural instability), however, worsened, and in parallel the initial improvement in activities of daily living scores at the 1 year follow-up had disappeared at 6 years, despite sustained improvement of tremor. Remarkably, neither daily doses of dopaminergic medication nor fluctuations and dyskinesias had changed at 6 years compared with baseline in this particular patient group.
Conclusion: This study confirms that patients with tremor dominant PD who do not present with fluctuations and dyskinesias may have a relatively benign progression of the disease. Vim DBS, although having no effect on akinesia and rigidity, is a relatively lenient surgical procedure and may still have a place for long term symptomatic control of PD tremor in selected patients.
Funding: The study was supported by Medtronic Bakken Research Centre, Maastricht, The Netherlands.
Competing interests: The study was initiated and supported by Medtronic.
Ethics approval: The initial study was approved by the ethics committees of the centres involved.