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In de afgelopen dertig jaar is diepe hersenstimulatie (‘deep brain stimulation’, DBS) een waardevolle en veilige behandeling gebleken voor patiënten met tremor bij wie medicamenteuze therapie onvoldoende effectief was. In de jaren tachtig en negentig van de vorige eeuw werd DBS van de nucleus ventralis intermedius (VIM) van de thalamus veelvuldig toegepast bij essentiële tremor (ET), de ziekte van Parkinson (ZvP) en multipele sclerose (MS). Aangezien bij ZvP-patiënten VIM DBS is vervangen voor DBS van de nucleus subthalamicus, en de effecten van VIM DBS bij MS-patiënten tegenvielen, wordt VIM DBS tegenwoordig met name toegepast bij ET en enkele zeldzamere vormen van tremor, zoals orthostatische tremor en holmes(rubrale)tremor. Het tremoronderdrukkend effect van VIM DBS bij ET-patiënten is de eerste jaren vaak zeer goed, maar na twee tot vijf jaar treedt dikwijls zogeheten DBS-tolerantie op, waardoor de tremor terugkeert. Het verder ophogen van de DBS is, vanwege bijwerkingen zoals paresthesieën, spiercontracties of dysartrie, niet altijd mogelijk. In recentere jaren is daarom uitgeweken naar andere regio’s zoals de ‘posterior subthalamic area’ (PSA). Toekomstig onderzoek zal uitwijzen wat de toegevoegde waarde van deze alternatieven is.

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van den Munckhof, P., Contarino, F., van Rootselaar, F. (2016). Diepe hersenstimulatie bij tremoraandoeningen. In: Temel, Y., Leentjens, A., de Bie, R. (eds) Handboek diepe hersenstimulatie bij neurologische en psychiatrische aandoeningen. Bohn Stafleu van Loghum, Houten. https://doi.org/10.1007/978-90-368-0959-7_12

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