Lesioning and stimulation in tremor-predominant movement disorder patients: an institutional case series and patient-reported outcome.
BACKGROUND
In certain movement disorder cases, a combined stimulation and lesioning approach in the same patient could be the ideal beneficial option.


OBJECTIVE
The object of this study was to retrospectively examine the indications, outcome and complications in patients who had undergone both a lesioning (thalamotomy) and deep brain stimulation (DBS) procedure (bilateral or unilateral) for a tremor-predominant movement disorder performed by a single surgeon at one institution over a 15-year period.


METHODS
A retrospective review of patient records was undertaken. Patient outcome was based on follow-up visit chart notes and on a non-validated patient telephone questionnaire.


RESULTS
Thirty patients required a combined stimulation and lesioning approach to control tremor. Twelve patients had either unilateral or bilateral DBS as the first procedure followed by thalamotomy; two patients required a third procedure. Eighteen patients had thalamotomy as the first procedure followed by contralateral DBS either as the second or the third procedure. Eight patients required three procedures, which included either a repeat thalamotomy or a repeat DBS. We were able to contact 22 of 30 (15 male and 15 female, average age 70.7 ± 15.4 years) tremor-predominant movement disorder patients, retrospectively. Patient-reported outcome as assessed by a non-validated telephone questionnaire was: improvement in both symptoms and function in 59%, symptom but not function improvement in 32% and no improvement in either symptom or function or worsening in 9%. In comparison, based on retrospective chart review, 77% of patients had improved symptoms and functions, 20% of patients had improved symptoms with no effect on function and 3% of patients had no improvements of symptoms or functions.


CONCLUSIONS
Lesioning, which has to a great extent fallen out of favor, still has a valuable role to play in the treatment of tremor-predominant movement disorders; it can still be applied in combination with stimulation with outcome results similar to that of bilateral stimulation.
Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA.
Diaa
D
Bahgat
Ahmed M
AM
Raslan
Shirley
S
McCartney
Kim J
KJ
Burchiel
D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000601:surgery / Q000628:therapy*; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013788:Thalamus / Q000601:surgery*; D016896:Treatment Outcome; D014202:Tremor / Q000601:surgery / Q000628:therapy*