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Thalamic Deep Brain Stimulation Essential Tremor: Recommendations Long-Term Outcome Analysis

Published online by Cambridge University Press:  02 December 2014

J.D. Putzke ,
R.E. Wharen, Jr. ,
A.A. Obwegeser ,
Z.K. Wszolek ,
J.A. Lucas ,
M.F. Turk  and
R.J. Uitti
J.D. Putzke
Affiliation:
Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
A.A. Obwegeser
Affiliation:
Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA and the Department of Neurosurgery University Innsbruck, Austria
Z.K. Wszolek
Affiliation:
Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
J.A. Lucas
Affiliation:
Department of Psychiatry, Mayo Clinic, Jacksonville, FL, USA
M.F. Turk
Affiliation:
Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
R.J. Uitti
Affiliation:
Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
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Abstract

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Objectives:

Determine the efficacy of thalamic deep brain stimulation (DBS) for tremor control among individuals with essential tremor (ET).

Methods:

A clinical series of 52 consecutive individuals undergoing placement of a DBS system for treatment of ET completed an unblinded battery of subjective and objective measures at postoperative intervals of one, three, and 12 months, and annually thereafter up to three years. The assessment battery included measures of tremor and activities of daily living.

Results:

Both subjective and objective measures showed that stimulation was associated with significant improvement at nearly every postoperative interval as compared to pre-operative and stimulation 'off' ratings of activities of daily living functioning, midline tremor, contralateral upper extremity tremor, and contralateral lower extremity tremor. Ipsilateral tremor showed some improvement with stimulation, but only within the first three months. Trend analysis showed stable tremor control. Stimulation settings remained largely unchanged after the first three months. Dysarthria was more common among those with bilateral stimulation. A range of missing data estimation methods were performed, and subsequent analyses corroborated the main findings of the study.

Conclusion:

Thalamic DBS is generally a well-tolerated and effective treatment for ET. Methodological and analytical recommendations are provided for the evaluation of long-term outcome.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 3 , August 2004 , pp. 333 - 342
Copyright
Copyright © The Canadian Journal of Neurological 2004

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