title: Deep brain stimulation of the ventral intermediate nucleus of the thalamus for control of tremors in Parkinson's disease and essential tremor.
abstract: The beneficial effects of ventral intermediate nucleus (VIM) stimulation were evaluated in 20 patients with tremor refractory to medical therapy. Thalamic stimulation is a non-ablative procedure which has the advantage of a reversible, non-destructive lesion. Eleven patients [7 with Parkinson's disease (PD) and 4 with essential tremor (ET)] received unilateral VIM implantation, while 9 patients had staged bilateral VIM implantation (4 with PD, 5 with ET). PD patients showed a significant improvement in contralateral arm and leg rest tremor and ipsilateral leg rest tremor (p < 0.02) at a mean follow-up period of 16.2 +/- 7.0 months. Patients with PD did not demonstrate any significant decrease in medication use at follow-up. ET patients demonstrated significant improvement in postural and action tremor in the contralateral arm (p < 0.001), but no significant improvement in the contralateral leg tremor at follow-up. Significant improvements were also seen in ET patients in the Clinical Rating Scale for Tremor (p < 0.001) with respect to several activities of daily living at a mean follow-up of 14.9 +/- 8. 1 months. Deep brain stimulation is a safe and effective treatment for severe tremor refractory to medications. It is a highly effective, reversible, adaptable, and predictable procedure which avoids the complication of cognitive deficit seen in patients with bilateral thalamotomies.
authors.affiliation: Department of Surgery, Section of Neurosurgery, Regina General Hospital, University of Saskatchewan, Regina, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Kumar
authors.forename: M
authors.initials: M
authors.lastname: Kelly
authors.forename: C
authors.initials: C
authors.lastname: Toth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology*; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014202:Tremor / Q000503:physiopathology / Q000628:therapy*; D020651:Ventral Thalamic Nuclei / Q000503:physiopathology*