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Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor

  • Clinical Article
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Abstract

Background

Deep brain stimulation (DBS) is an effective treatment for essential tremor (ET). Currently the ventrolateral thalamus is the target of choice, but the posterior subthalamic area (PSA), including the caudal zona incerta (cZi), has demonstrated promising results, and the subthalamic nucleus (STN) has been suggested as a third alternative. The objective of the current study was to evaluate the effect of STN DBS in ET and to compare this to cZi DBS.

Methods

Four patients with ET were implanted with two ipsilateral electrodes, one in the STN and one in the cZi. All contacts were evaluated concerning the acute effect on tremor, and the effect of chronic DBS in either target was analyzed.

Results

STN and cZi both proved to be potent targets for DBS in ET. DBS in the cZi was more efficient, since the same degree of tremor reduction could here be achieved at lower energy consumption. Three patients became tremor-free in the treated hand with either STN or cZi DBS, while the fourth had a minor residual tremor after stimulation in either target.

Conclusion

In this limited material, STN DBS was demonstrated to be an efficient treatment for ET, even though cZi DBS was more efficient. The STN may be an alternative target in the treatment of ET, pending further investigations to decide on the relative merits of the different targets.

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Acknowledgements

This work was supported by grants from the University of Umeå and from the Foundation for Clinical Neuroscience at the University Hospital of Umeå. Marwan Hariz is supported by the Parkinson Appeal U.K. He has occasionally received honoraria from Medtronic for speaking at meetings. The authors have nothing further to acknowledge.

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Authors and Affiliations

  1. Department of Clinical Neuroscience, section of Neurosurgery, Umeå University, Umeå, Sweden

    Patric Blomstedt, Ulrika Sandvik & Marwan I. Hariz

  2. Department of Clinical Neuroscience, section of Neurology, Umeå University, Umeå, Sweden

    Jan Linder, Anna Fredricks & Lars Forsgren

  3. UCL Institute of Neurology, Queen Square, London, UK

    Marwan I. Hariz

  4. Department of Neurosurgery, University Hospital of Northern Sweden, 90185, Umeå, Sweden

    Patric Blomstedt

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  1. Patric Blomstedt
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  2. Ulrika Sandvik
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  3. Jan Linder
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  4. Anna Fredricks
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  5. Lars Forsgren
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  6. Marwan I. Hariz
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Correspondence to Patric Blomstedt.

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Blomstedt, P., Sandvik, U., Linder, J. et al. Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor. Acta Neurochir 153, 2329–2335 (2011). https://doi.org/10.1007/s00701-011-1157-4

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  • DOI: https://doi.org/10.1007/s00701-011-1157-4

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