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Neurotherapeutics

, Volume 5, Issue 2, pp 331–338 | Cite as

Deep brain stimulation and tremor

Deep Brain Stimulation

Summary

Deep brain stimulation (DBS) has been used to treat various tremor disorders for several decades. Medication-resistant, disabling essential tremor (ET) is the most common tremor disorder treated with DBS. The treatment has been consistently reported to result in significant benefit in upper extremity, as well as head and voice tremor, all of which were improved more dramatically with bilateral procedures. These benefits have been demonstrated to be sustained for up to 7 years. DBS has also been shown to be beneficial for the tremor associated with multiple sclerosis and post-traumatic tremor; however, fewer cases have been reported and the benefit is less consistent, less dramatic, and more transient than that seen with ET. The ventral intermediate nucleus of the thalamus is the most common DBS target for tremor disorders, but more recent studies have demonstrated benefits in tremor from DBS of the subthalamic area, primarily the zona incerta. Surgical complications are relatively uncommon and are generally less frequent than those seen with thalamotomy. Stimulation-related effects are usually mild and resolve with adjustment of stimulation parameters. DBS is thus a relatively safe and effective treatment for tremor disorders, particularly for medication-resistant, disabling ET, but may also have some role in medication-resistant, disabling tremor associated with multiple sclerosis and traumatic head injury.

Key Words

Deep brain stimulation tremor essential tremor primary writing tremor multiple sclerosis tremor post-traumatic tremor 
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References

  1. 1.
    Deuschl G, Bain P, Brin M; Ad Hoc Scientific Committee. Consensus statement of the Movement Disorder Society on Tremor. Mov Disord 1998;13 Suppl 3: 2–23.PubMedGoogle Scholar
  2. 2.
    Lyons KE, Pahwa R, Comella CL, et al. Benefits and risks of pharmacological treatments for essential tremor. Drug Saf 2003; 26: 461–481.CrossRefPubMedGoogle Scholar
  3. 3.
    Olanow CW, Watts RL, Koller WC. An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines. Neurology 2001;56(11 Suppl 5): S1-S88.PubMedGoogle Scholar
  4. 4.
    Pahwa R, Lyons KE. Essential tremor: differential diagnosis and current therapy. Am J Med 2003;115: 134–142.CrossRefPubMedGoogle Scholar
  5. 5.
    Deuschl G, Bain P. Deep brain stimulation for trauma [collection of trauma]: patient selection and evaluation. Mov Disord 2002; 17(Supp13): S102-S111.CrossRefPubMedGoogle Scholar
  6. 6.
    Hassler R, Riechert T, Mundinger F, Umbach W, Ganglberger JA. Physiological observations in stereotaxic operations in extrapyramidal motor disturbances. Brain 1960;83: 337–350.CrossRefPubMedGoogle Scholar
  7. 7.
    Benabid AL, Pollak P, Gao D, et al. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg 1996;84: 203–214.CrossRefPubMedGoogle Scholar
  8. 8.
    Tasker RR. Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol 1998;49: 145–153; discussion 153–154.CrossRefPubMedGoogle Scholar
  9. 9.
    Schuurman PR, Bosch DA, Bossuyt PM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med 2000;342: 461–468.CrossRefPubMedGoogle Scholar
  10. 10.
    Pahwa R, Lyons KE, Wilkinson SB, et al. Comparison of thalamotomy to deep brain stimulation of the thalamus in essential tremor. Mov Disord 2001;16: 140–143.CrossRefPubMedGoogle Scholar
  11. 11.
    Koller W, Pahwa R, Busenbark K, et al. High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol 1997;42: 292–299.CrossRefPubMedGoogle Scholar
  12. 12.
    Pahwa R, Lyons KE, Wilkinson SB, et al. Long-term evaluation of deep brain stimulation of the thalamus. J Neurosurg 2006;104: 506–512.CrossRefPubMedGoogle Scholar
  13. 13.
    Limousin P, Speelman JD, Gielen F, Janssens M. Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 1999;66: 289–296.CrossRefPubMedGoogle Scholar
  14. 14.
    Sydow O, Thobois S, Alesch F, Speelman JD. Multicentre European study of thalamic stimulation in essential tremor: a six year follow up. J Neurol Neurosurg Psychiatry 2003;74: 1387–1391.CrossRefPubMedGoogle Scholar
  15. 15.
    Koller WC, Lyons KE, Wilkinson SB, Troster AI, Pahwa R. Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor. Mov Disord 2001;16: 464–468.CrossRefPubMedGoogle Scholar
  16. 16.
    Putzke JD, Wharen RE Jr, Obwegeser AA, et al. Thalamic deep brain stimulation for essential tremor: recommendations for long-term outcome analysis. Can J Neurol Sci 2004;31: 333–342.PubMedGoogle Scholar
  17. 17.
    Ondo W, Jankovic J, Schwartz K, Almaguer M, Simpson RK. Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson’s disease tremor. Neurology 1998;51: 1063–1069.PubMedGoogle Scholar
  18. 18.
    Blond S, Siegfried J. Thalamic stimulation for the treatment of tremor and other movement disorders. Acta Neurochir Suppl 1991; 52: 109–111.Google Scholar
  19. 19.
    Alesch F, Pinter MM, Helscher RJ, Fertl L, Benabid AL, Koos WT. Stimulation of the ventral intermediate thalamic nucleus in tremor dominated Parkinson’s disease and essential tremor. Acta Neurochir 1995;136: 75–81.CrossRefGoogle Scholar
  20. 20.
    Hariz GM, Bergenheim AT, Hariz MI, Lindberg M. Assessment of ability/disability in patients treated with chronic thalamic stimulation for tremor. Mov Disord 1998;13: 78–83.CrossRefPubMedGoogle Scholar
  21. 21.
    Kumar K, Kelly M, Toth C. Deep brain stimulation of the ventral intermediate nucleus of the thalamus for control of tremors in Parkinson’s disease and essential tremor. Stereotact Funct Neurosurg 1999;72: 47–61.CrossRefPubMedGoogle Scholar
  22. 22.
    Krauss JK, Simpson RK Jr, Ondo WG, Pohle T, Burgunder JM, Jankovic J. Concepts and methods in chronic thalamic stimulation for treatment of tremor: technique and application. Neurosurgery 2001;48: 535–541; discussion 541-533.CrossRefPubMedGoogle Scholar
  23. 23.
    Rehncrona S, Johnels B, Widner H, Tornqvist AL, Hariz M, Sydow O. Long-term efficacy of thalamic deep brain stimulation for tremor: double-blind assessments. Mov Disord 2003;18: 163–170.CrossRefPubMedGoogle Scholar
  24. 24.
    Putzke JD, Wharen RE Jr, Wszolek ZK, Turk MF, Strongosky AJ, Uitti RJ. Thalamic deep brain stimulation for tremor-predominant Parkinson’s disease. Parkinsonism Relat Disord 2003;10: 81–88.CrossRefPubMedGoogle Scholar
  25. 25.
    Putzke JD, Uitti RJ, Obwegeser AA, Wszolek ZK, Wharen RE. Bilateral thalamic deep brain stimulation: midline tremor control. J Neurol Neurosurg Psychiatry 2005;76: 684–690.CrossRefPubMedGoogle Scholar
  26. 26.
    Koller WC, Lyons KE, Wilkinson SB, Pahwa R. Efficacy of unilateral deep brain stimulation of the VIM nucleus of the thalamus for essential head tremor. Mov Disord 1999;14: 847–850.CrossRefPubMedGoogle Scholar
  27. 27.
    Berk C, Honey CR. Bilateral thalamic deep brain stimulation for the treatment of head tremor: report of two cases. J Neurosurg 2002;96: 615–618.CrossRefPubMedGoogle Scholar
  28. 28.
    Kitagawa M, Murata J, Kikuchi S, et al. Deep brain stimulation of subthalamic area for severe proximal tremor. Neurology 2000; 55: 114–116.PubMedGoogle Scholar
  29. 29.
    Murata J, Kitagawa M, Uesugi H, et al. Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor. J Neurosurg 2003;99: 708–715.CrossRefPubMedGoogle Scholar
  30. 30.
    Plaha P, Patel NK, Gill SS. Stimulation of the subthalamic region for essential tremor. J Neurosurg 2004;101: 48–54.CrossRefPubMedGoogle Scholar
  31. 31.
    Minguez-Castellanos A, Carnero-Pardo C, Gómez-Camello A, et al. Primary writing tremor treated by chronic thalamic stimulation. Mov Disord 1999;14: 1030–1033.CrossRefPubMedGoogle Scholar
  32. 32.
    Racette BA, Dowling J, Randle J, Mink JW. Thalamic stimulation for primary writing tremor. J Neurol 2001;248: 380–382.CrossRefPubMedGoogle Scholar
  33. 33.
    Geny C, Nguyen JP, Pollin B, et al. Improvement of severe postural cerebellar tremor in multiple sclerosis by chronic thalamic stimulation. Mov Disord 1996;11: 489–494.CrossRefPubMedGoogle Scholar
  34. 34.
    Montgomery EB Jr, Baker KB, Kinkel RP, Barnett G. Chronic thalamic stimulation for the tremor of multiple sclerosis. Neurology 1999;53: 625–628.PubMedGoogle Scholar
  35. 35.
    Schulder M, Sernas T, Mahalick D, Adler R, Cook S. Thalamic stimulation in patients with multiple sclerosis. Stereotact Funct Neurosurg 1999;72: 196–201.CrossRefPubMedGoogle Scholar
  36. 36.
    Schulder M, Sernas TJ, Karimi R. Thalamic stimulation in patients with multiple sclerosis: long-term follow-up. Stereotact Funct Neurosurg 2003;80: 48–55.CrossRefPubMedGoogle Scholar
  37. 37.
    Berk C, Carr J, Sinden M, Martzke J, Honey CR. Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life. J Neurosurg 2002;97: 815–820.CrossRefPubMedGoogle Scholar
  38. 38.
    Wishart HA, Roberts DW, Roth RM, et al. Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports. J Neurol Neurosurg Psychiatry 2003;74: 1392–1397.CrossRefPubMedGoogle Scholar
  39. 39.
    Yap L, Kouyialis A, Varma TR. Stereotactic neurosurgery for disabling tremor in multiple sclerosis: thalamotomy or deep brain stimulation? Br J Neurosurg 2007;21: 349–354.CrossRefPubMedGoogle Scholar
  40. 40.
    Nandi D, Aziz TZ. Deep brain stimulation in the management of neuropathic pain and multiple sclerosis tremor. J Clin Neurophysiol 2004;21: 31–39.CrossRefPubMedGoogle Scholar
  41. 41.
    Krauss JK, Jankovic J. Head injury and posttraumatic movement disorders. Neurosurgery 2002;50: 927–939; discussion 939–940.CrossRefPubMedGoogle Scholar
  42. 42.
    Broggi G, Brock S, Franzini A, Geminiani G. A case of posttraumatic tremor treated by chronic stimulation of the thalamus. Mov Disord 1993;8: 206–208.CrossRefPubMedGoogle Scholar
  43. 43.
    Umemura A, Samadani U, Jaggi JL, Hurtig HI, Baituch GH. Thalamic deep brain stimulation for posttraumatic action tremor. Clin Neurol Neurosurg 2004;106: 280–283.CrossRefPubMedGoogle Scholar
  44. 44.
    Foote KD, Okun MS. Ventralis intermedius plus ventralis oralis anterior and posterior deep brain stimulation for posttraumatic Holmes tremor: two leads may be better than one: technical note. Neurosurgery 2005;56(2 Suppl): E445.CrossRefPubMedGoogle Scholar

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2008

Authors and Affiliations

  1. 1.Parkinson’s Disease and Movement Disorder Center, Department of NeurologyUniversity of Kansas Medical CenterKansas City

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