title: Ten Hertz thalamus stimulation increases tremor activity in the subthalamic nucleus in a patient with Parkinson's disease.
abstract: OBJECTIVE
  In patients with Parkinson's disease (PD) the effect of thalamic stimulation on tremor pathophysiology remains largely unclear. By recording local field potentials (LFPs) in the subthalamic nucleus (STN) while stimulating the nucleus ventralis intermedius thalami (VIM), information of the stimulation effects should be gained.
  
  
  METHODS
  We had the unique opportunity to intraoperatively record LFPs of the STN in a patient with PD while stimulating the VIM. VIM electrodes had been implanted 9 years previously because of tremor. Due to worsening of clinical symptoms an implantation of STN electrodes had become necessary.
  
  
  RESULTS
  High frequency stimulation in the VIM lowered the power of the tremor frequency band (4-7Hz) in the STN. In contrast, 10Hz VIM stimulation elevated the power of the tremor frequency band as well as STN-EMG coupling.
  
  
  CONCLUSIONS
  The effect of high frequency stimulation may explain the improvement of tremor in patients who are treated with VIM deep brain stimulation. The power elevation during 10Hz stimulation suggests that the pathological cerebral and cerebral-muscular communication in PD is mainly driven at 10Hz.
  
  
  CONCLUSIONS
  The direct cerebral recordings support the view that a 10Hz network is a pathophysiological key mechanism in the generation of motor deficits in PD.
authors.affiliation: Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937 Köln, Cologne, Germany. e.florin@fz-juelich.de
authors.forename: Esther
authors.initials: E
authors.lastname: Florin
authors.forename: Christiane
authors.initials: C
authors.lastname: Reck
authors.forename: Lothar
authors.initials: L
authors.lastname: Burghaus
authors.forename: Ralph
authors.initials: R
authors.lastname: Lehrke
authors.forename: Joachim
authors.initials: J
authors.lastname: Gross
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D004576:Electromyography / Q000379:methods; D005071:Evoked Potentials / Q000528:radiation effects; D005583:Fourier Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000473:pathology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D013788:Thalamus / Q000528:radiation effects*; D014202:Tremor / Q000209:etiology*