title: Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor.
abstract: BACKGROUND
  Deep brain stimulation (DBS) is an effective treatment for essential tremor (ET). Currently the ventrolateral thalamus is the target of choice, but the posterior subthalamic area (PSA), including the caudal zona incerta (cZi), has demonstrated promising results, and the subthalamic nucleus (STN) has been suggested as a third alternative. The objective of the current study was to evaluate the effect of STN DBS in ET and to compare this to cZi DBS.
  
  
  METHODS
  Four patients with ET were implanted with two ipsilateral electrodes, one in the STN and one in the cZi. All contacts were evaluated concerning the acute effect on tremor, and the effect of chronic DBS in either target was analyzed.
  
  
  RESULTS
  STN and cZi both proved to be potent targets for DBS in ET. DBS in the cZi was more efficient, since the same degree of tremor reduction could here be achieved at lower energy consumption. Three patients became tremor-free in the treated hand with either STN or cZi DBS, while the fourth had a minor residual tremor after stimulation in either target.
  
  
  CONCLUSIONS
  In this limited material, STN DBS was demonstrated to be an efficient treatment for ET, even though cZi DBS was more efficient. The STN may be an alternative target in the treatment of ET, pending further investigations to decide on the relative merits of the different targets.
authors: Department of Clinical Neuroscience, section of Neurosurgery, Umeå University, Umeå, Sweden. patric.blomstedt@neuro.umu.se
authors: Patric
authors: P
authors: Blomstedt
authors: Ulrika
authors: U
authors: Sandvik
authors: Jan
authors: J
authors: Linder
authors: Anna
authors: A
authors: Fredricks
authors: Lars
authors: L
authors: Forsgren
authors: Marwan I
authors: MI
authors: Hariz
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted / Q000592:standards; D020329:Essential Tremor / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020531:Subthalamic Nucleus / Q000503:physiopathology / Q000601:surgery*; D020530:Subthalamus / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome