Long-term suppression of extrapyramidal motor symptoms with deep brain stimulation (DBS).
Deep Brain Stimulation (DBS) was investigated for the treatment of extrapyramidal motor symptoms. Both tremor and rigidity as well as akinesia are known to be permanently suppressed by applying a high-frequency current to different basal ganglia nuclei. Chronic DBS was performed in 113 patients using stereotactically implanted quadripolar electrodes in the ventrolateral thalamus (n = 43), the globus pallidus internus (n = 15), or the subthalamic nucleus (n = 55). Subcutaneous implantation of the generator occurred during a second procedure following correct positioning of the electrodes and confirmation of effectiveness by external stimulation. Patients were followed up using standardized rating scales before and after surgery. Deep Brain Stimulation significantly suppresses extrapyramidal symptoms such as tremor (p < 0.001), rigidity (p < 0.001), dyskinesia (p < 0.01), akinesia, and dystonia (p < 0.05). Permanent side effects were avoided by changing the stimulation parameters. Severe complications occurred in only two patients (n = 2, 1.8 %). DBS is a safe and effective long-term treatment for tremor, rigidity, dyskinesia, akinesia and dystonia.
Department of Neurosurgery, University Medical Centre Benjamin Franklin, Berlin, Germany. vesper@medizin.fu-berlin.de
J
J
Vesper
F
F
Klostermann
C
C
Wille
T
T
Funk
M
M
Brock
D000328:Adult; D001480:Basal Ganglia Diseases / Q000628:therapy*; D001921:Brain / Q000502:physiology*; D020820:Dyskinesias / Q000628:therapy; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D005917:Globus Pallidus / Q000502:physiology; D006801:Humans; D008297:Male; D009127:Muscle Rigidity / Q000628:therapy; D019635:Neurosurgical Procedures / Q000009:adverse effects; D013238:Stereotaxic Techniques; D014202:Tremor / Q000628:therapy; D020651:Ventral Thalamic Nuclei / Q000502:physiology