The effects of subthalamic nucleus deep brain stimulation on parkinsonian tremor.
Deep brain stimulation (DBS) of the ventral intermediate (Vim) nucleus of the thalamus has been the target of choice for patients with disabling essential tremor or medication refractory parkinsonian tremor. Recently there is evidence that the subthalamic nucleus (STN) should be the targets for patients with tremor associated with Parkinson's disease (PD). To assess the effects of STN DBS on parkinsonian tremor, eight consecutive patients with PD and disabling tremor were videotaped using a standardized tremor protocol. Evaluations were performed at least 12 h after last dose of medication with the DBS turned off followed by optimal DBS on state. A rater blinded to DBS status evaluated randomized video segments with the tremor components of the Unified Parkinson Disease Rating Scale (UPDRS) and Tremor Rating Scale (TRS). Compared with DBS off state there were significant improvements in mean UPDRS tremor score 79.4% (p=0.008), total TRS score 69.9% (p=0.008) and upper extremity 92.5% (p=0.008) TRS subscore. Functional improvement was noted with pouring liquids. Our findings provide support that STN DBS is an effective treatment of tremor associated with PD.
Diamond
Alan
A
Department of Neurology, Baylor College of Medicine, United States. neurodoc01@sbcglobal.net
Shahed
Joohi
J
Jankovic
Joseph
J
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001479:Basal Ganglia / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000379:methods* / Q000639:trends; D004566:Electrodes / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D020651:Ventral Thalamic Nuclei / Q000503:physiopathology
D000978:Antiparkinson Agents