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Deep brain stimulation in the nucleus ventralis intermedius in patients with essential tremor: habituation of tremor suppression

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Abstract

In patients with essential tremor (ET) already treated with chronic deep brain stimulation (DBS) of the nucleus ventralis intermedius (VIM) we investigated whether optimization of stimulation parameters could improve clinical tremor suppression, and whether this putative effect could be sustained over time. Twenty-three ET patients with VIM-DBS participated in the prospective study. All electrode contacts were tested systematically and stimulation parameters were optimized over the course of 2 days. Clinical tremor rating scale (TRS) was videotaped before, directly after the optimization and at a 10 weeks follow-up and evaluated blindly and independently by two clinicians. For stimulation effect optimization we increased the number of active contacts whereas the total charge applied to the tissue was kept constant. TRS hemi-body scores decreased significantly after optimization. At the 10 weeks follow-up, however, the improvement had faded and was no longer significant. The activities of daily living (ADL) remained significantly improved. Systematic optimization of VIM-DBS parameters in ET patients leads to a short term improvement which habituates over time. Our results provide further evidence for a tolerance effect in chronic VIM stimulation thereby suggesting that frequently alternating stimulation protocols should be tested in future studies of ET patients treated with VIM-DBS.

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Acknowledgments

We thank the patients for study participation and cooperation. This study was supported by a grant of the German Research Foundation (DFG), Clinical Research Group 219 (KFO 219) to L.T. and G.R.F (TI 319/2-1, FI 773/8-1 and SCHU 1439/3-1).

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Authors and Affiliations

  1. Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Michael T. Barbe, Lena Liebhart, K. Amande M. Pauls, Gereon R. Fink & Lars Timmermann

  2. Cognitive Neurology Section, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425, Jülich, Germany

    Michael T. Barbe & Gereon R. Fink

  3. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany

    Matthias Runge, Volker Sturm & Mohammad Maarouf

  4. Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University, Düsseldorf, Germany

    Lars Wojtecki & Alfons Schnitzler

  5. Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany

    Lars Wojtecki & Alfons Schnitzler

  6. Neurological Rehabilitation Center Godeshoehe, Waldstrasse 2-10, 53177, Bonn, Germany

    Niels Allert

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  1. Michael T. Barbe
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  2. Lena Liebhart
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  3. Matthias Runge
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  4. K. Amande M. Pauls
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  5. Lars Wojtecki
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  6. Alfons Schnitzler
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  7. Niels Allert
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  8. Gereon R. Fink
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  9. Volker Sturm
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  10. Mohammad Maarouf
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  11. Lars Timmermann
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Corresponding authors

Correspondence to Michael T. Barbe or Lars Timmermann.

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Barbe, M.T., Liebhart, L., Runge, M. et al. Deep brain stimulation in the nucleus ventralis intermedius in patients with essential tremor: habituation of tremor suppression. J Neurol 258, 434–439 (2011). https://doi.org/10.1007/s00415-010-5773-3

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  • DOI: https://doi.org/10.1007/s00415-010-5773-3

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