Article Text

Download PDFPDF
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;


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.

  • DBS, deep brain stimulation
  • IPG, implantable pulse generator
  • TRS, tremor rating scale
  • Vim, ventral intermediate (nucleus)
  • deep brain stimulation
  • essential tremor

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


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

  • Competing interests: none declared