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Cognitive effects of deep brain stimulation for essential tremor: evaluation at 1 and 6 years

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

Only a few studies have explored cognitive changes with deep brain stimulation (DBS) in patients with essential tremor (ET). Furthermore, the cognitive effects after years of electrical stimulation are unknown. Assessing the impact of stereotactic electrode implantation and the actual electrical stimulation on cognition in patients with ET in the short and long term is of interest, because DBS is increasingly applied and can offer deeper insight into human brain functions. We examined nine ET patients before surgery (PRE-SURGERY), and 1 and 6 years thereafter with DBS switched on (DBS-ON) and off (DBS-OFF). Standardized neuropsychological tests and reaction time tests were applied. There were no differences in tasks of verbal fluency, memory, and executive and intellectual functions comparing PRE-SURGERY, DBS-ON, and DBS-OFF at 1 and 6 years post-surgery. Imaging data revealed that the dorsolateral prefrontal cortex and mamillo-thalamic tracts crucial for cognitive functioning were spared by electrode implantation. Additionally, with electrodes targeting the thalamus and adjacent subthalamic area, the actual electrical stimulation did not affect neuropsychological functioning. However, lesions caused by electrode implantation led to an increase in simple reaction time, while the actual electrical stimulation restored impaired reaction time. This is the second largest study of neuropsychological functioning in patients with ET treated with DBS, and the first covering a neuropsychological long-term follow-up over 6 years. Neither stereotactic surgery nor electrical stimulation affected higher cognitive processes. This study proposes that cerebello-thalamo-cortical pathways in humans are involved in tasks of simple reaction time.

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Acknowledgments

This research project was supported by the START-Program of the Faculty of Medicine, RWTH Aachen University.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Neuropsychology, Department of Neurology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52064, Aachen, Germany

    Ines A. Heber & Bruno Fimm

  2. Department of Stereotactic and Functional Neurosurgery, Freiburg University Hospital, Breisacher Strasse 64, 79106, Freiburg, Germany

    Volker A. Coenen

  3. Department of Neurology, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany

    Kathrin Reetz, Jörg B. Schulz & Martin Kronenbuerger

  4. JARA, Translational Brain Medicine, Pauwelsstrasse 30, 52074, Aachen, Germany

    Kathrin Reetz & Jörg B. Schulz

  5. Institute of Neuroscience and Medicine, Research Center Jülich GmbH, Wilhelm-Johnen-Straße, 52428, Jülich, Germany

    Kathrin Reetz

  6. Department of Neurosurgery, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52064, Aachen, Germany

    Anke Hoellig

Authors
  1. Ines A. Heber
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  2. Volker A. Coenen
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  3. Kathrin Reetz
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  4. Jörg B. Schulz
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  5. Anke Hoellig
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  6. Bruno Fimm
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  7. Martin Kronenbuerger
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Corresponding author

Correspondence to Martin Kronenbuerger.

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B. Fimm and M. Kronenbuerger gave equal contribution to this manuscript.

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Heber, I.A., Coenen, V.A., Reetz, K. et al. Cognitive effects of deep brain stimulation for essential tremor: evaluation at 1 and 6 years. J Neural Transm 120, 1569–1577 (2013). https://doi.org/10.1007/s00702-013-1030-0

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  • DOI: https://doi.org/10.1007/s00702-013-1030-0

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