Abstract
Deep brain stimulation (DBS) has become an important option for medication-refractory essential tremor (ET), but may contribute to worsened gait and falling. This study evaluates impaired gait in a cohort of patients treated with DBS with a retrospective review of ET patients before and after DBS implantation. Factors examined included: age, duration of symptoms, pre-morbid gait difficulties/falls, Fahn-Tolosa-Marin tremorrating scale (TRS) scores at baseline, 6 months post-unilateral DBS implantation, and 6 or 12 months post-bilateral implantation. All implantations targeted the nucleus ventralis intermediate (Vim). Thirty-eight patients (25 males, 13 females) were included. Twenty-five patients (65.8%) underwent unilateral DBS implantation and 13 (34.2%) bilateral. The mean age at surgery was 67.1 years ± 11.4 (range 34–81). The mean disease duration was 31 years ± 18.3 (range 6–67). Fifty-eight percent of patients had worsened gait post-operatively. Seventy percent of patients with unilateral Vim DBS experienced gait worsening while 55% of bilateral DBS patients experienced gait worsening. Patients with worsened gait post-DBS had higher baseline pre-operative TRS scores than those without worsened gait (43.1 points ± 8.4 vs. 33.1 points ± 10.1, p = 0.002) (odds ratio 2.5, p = 0.02). Gait/balance may worsen following DBS for medication refractory ET. Higher baseline TRS score may factor into these issues, although a larger prospective study will be required with a control population. The larger percentage of difficulties observed in unilateral versus bilateral cases likely reflected the bias to not proceed to second-sided surgery if gait/balance problems were encountered.
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Conflict of interest
Dr. Hwynn, Dr. Hass, Mrs. Zeilman, Ms. Romrell, Mr. Dai, Dr. Subramony, Dr. Oyama, Dr. Velez-Lago, and Mr. Resnick report nothing to disclose. Dr. Wu received personal compensation from Bioness Inc. for consulting services and from the Journal of Physical Therapy for serving as a statistical reviewer. Dr. Foote has received Medtronic fellowship training and research grants and has participated in CME activities on movement disorders sponsored by the University of South Florida CME office. Dr. Fernandez received personal compensation for being Medical Editor of the Movement Disorders Society Website and financial support for research activities from: National Institute of Neurological Disorders and Stroke, Michael J. Fox Foundation, National Parkinson Foundation, Movement Disorders Society, Huntington Study Group, Acadia, AstraZeneca, Solvay Pharmaceuticals, and Teva Pharmaceuticals. Dr. Malaty has received grant support from the National Parkinson Foundation. Dr. Okun serves as a consultant for the National Parkinson Foundation, and has received research grants from the National Institutes of Health, National Parkinson Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, Medtronic peer-reviewed fellowship training grants, and the UF Foundation. Dr. Okun has in the past received honoraria for Deep Brain Stimulation educational talks prior to 2010, but currently receives no support. Dr. Okun has received royalties for publications with Demos, Manson, and Cambridge (movement-disorders books). Dr. Okun has potential royalty interest in the COMPRESS tool for Deep Brain Stimulation. Dr. Okun has participated in CME activities on movement disorders sponsored by the University of South Florida CME office.
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Hwynn, N., Hass, C.J., Zeilman, P. et al. Steady or not following thalamic deep brain stimulation for essential tremor. J Neurol 258, 1643–1648 (2011). https://doi.org/10.1007/s00415-011-5986-0
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DOI: https://doi.org/10.1007/s00415-011-5986-0