gms | German Medical Science

65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. - 14. Mai 2014, Dresden

Deep brain stimulation for essential tremor in the elderly – a single center analysis

Meeting Abstract

  • Johann Klein - Klinik für Neurologie und Klinik für Stereotaktische Neurochirurgie, Leibniz-Institut für Neurobiologie, Klinikum der Otto-von-Guericke-Universität, Magdeburg
  • Andreas Kupsch - Klinik für Neurologie und Klinik für Stereotaktische Neurochirurgie, Leibniz-Institut für Neurobiologie, Klinikum der Otto-von-Guericke-Universität, Magdeburg
  • Imke Galazky - Klinik für Neurologie und Klinik für Stereotaktische Neurochirurgie, Leibniz-Institut für Neurobiologie, Klinikum der Otto-von-Guericke-Universität, Magdeburg
  • Lars Büntjen - Klinik für Neurologie und Klinik für Stereotaktische Neurochirurgie, Leibniz-Institut für Neurobiologie, Klinikum der Otto-von-Guericke-Universität, Magdeburg
  • Hans-Jochen Heinze - Klinik für Neurologie und Klinik für Stereotaktische Neurochirurgie, Leibniz-Institut für Neurobiologie, Klinikum der Otto-von-Guericke-Universität, Magdeburg
  • Jürgen Voges - Klinik für Neurologie und Klinik für Stereotaktische Neurochirurgie, Leibniz-Institut für Neurobiologie, Klinikum der Otto-von-Guericke-Universität, Magdeburg

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.06.01

doi: 10.3205/14dgnc025, urn:nbn:de:0183-14dgnc0259

Veröffentlicht: 13. Mai 2014

© 2014 Klein et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Deep brain stimulation (DBS) in the nucleus ventralis intermedius of the thalamus (VIM) is an established methodology for the treatment of essential tremor (ET). However, data on the outcome in elderly patients is sparse. We thus aimed at evaluating safety and efficacy of the procedure in patients >70 years vs. Patients <70 years.

Method: All patients stimulated in the VIM between 2007 and 2013 at our institution were included in a retrospective analysis and their medical records were reviewed. To compare the outcome, we split the patients in a group >70 years and a group <70 years at the time of surgery. Outcome parameters comprised the Fahn-Tolosa-Marin tremor rating score (FTM), Mattis Dementia Rating Scale, Frontal Assessment Battery (FAB), Quality of Life in Essential Tremor (QUEST), Beck Depression Inventory II (BDI-II), Activities of Daily Living (ADL), and adverse events.

Results: We identified 29 consecutive patients treated with bilateral VIM stimulation for ET (14 male). 14 patients were included in the younger group (mean age 59.5 ± 8.8, range 43-68) and 15 patients in the older group (mean age 73.3 ± 2.6, range 70- 79). For 27 patients, postoperative data was available. One patient per group was lost to follow-up. Mean follow-up time was 14.9 months in the older group (range 3- 80) and 18.8 months in the younger group (range 3-70). Postoperative CT excluded intracranial hemorrhage in all cases. There was no perioperative morbidity or mortality. Four patients of the younger group underwent revision surgery (two wound revisions, one electrode replacement followed by electrode removal, and one system removal followed by wound revision; all but two within six weeks of the initial surgery). None of the older patients had to be re-operated. Mean postoperative FTM score did not differ between the groups in the on-stimulation state (18.3 vs. 17.5, p = 0.75). Cognitive capacities were equal (FAB: 16.8 vs. 15.5, p = 0.22; MDRS: 136.6 vs. 134.8, p = 0.92). BDI-II was lower in the older group (13.4 vs. 5.6, p = 0.02) after equal preoperative values (16.6 vs. 17.5, p = 0.83). The QUEST (38.6 vs 25.5, p = 0.11) and ADL (22.1 vs. 21.0, p = 0.70) showed no significant differences.

Conclusions: VIM-DBS is safe and efficient in patients aged 70 years or older. No higher risk or lower efficacy could be identified when compared to patients <70 years. Depression might be influenced more favorably in the elderly.