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Abstract
Objective To evaluate deep brain stimulation (DBS) of the posterior subthalamic area (PSA) in essential tremor (ET) and compare it to the ventral intermediate nucleus of the thalamus (VIM) in terms of stimulation efficacy, efficiency, and side effects.
Methods DBS leads were implanted such that contacts were placed in the VIM, on the intercommissural line, and in the PSA. Thirteen patients with ET entered a randomized, double-blind crossover phase and completed a 1-year follow-up.
Results PSA-DBS significantly reduced tremor severity and improved quality of life. There were no relevant differences in quality and frequency of stimulation side effects between VIM and PSA, with a tendency toward greater tremor improvement with PSA stimulation. Clinical benefit was achieved at significantly lower stimulation amplitudes in the PSA. The majority of patients remained with PSA-DBS after 1 year.
Conclusion In accordance with previous retrospective investigations, our prospective data suggest that PSA-DBS is at least equally effective as but possibly more efficient than VIM-DBS.
Classification of evidence This study provides Class I evidence that for patients with essential tremor, PSA-DBS is not significantly different from VIM-DBS in suppressing tremor, but clinical benefit from PSA-DBS is attained at lower stimulation amplitudes.
Glossary
- AE=
- adverse event;
- BDI=
- Beck Depression Inventory;
- CI=
- confidence interval;
- DBS=
- deep brain stimulation;
- DRTT=
- dentato-rubro-thalamic tract;
- ET=
- essential tremor;
- ICARS=
- International Cooperative Ataxia Rating Scale;
- ICL=
- intercommissural line;
- OSF=
- Open Science Framework;
- PSA=
- posterior subthalamic area;
- QUEST=
- Quality of Life in Essential Tremor Questionnaire;
- SF-36=
- Short Form 36 Health Survey Questionnaire;
- TRS=
- Tremor Rating Scale;
- VAS=
- visual analog scale;
- VIM=
- ventral intermediate nucleus of the thalamus
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 247
Class of Evidence: NPub.org/coe
- Received October 26, 2017.
- Accepted in final form May 17, 2018.
- © 2018 American Academy of Neurology
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- Reader response: DBS of the PSA and the VIM in essential tremor: A randomized, double-blind, crossover trial
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