gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Treatment of essential and dystonic head tremor by subthalamic or pallidal deep brain stimulation

Meeting Abstract

  • C. Buhmann - Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
  • C.K.E. Moll - Institut für Neurophysiologie & Pathophysiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
  • S. Zittel - Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
  • A. Gulberti - Institut für Neurophysiologie & Pathophysiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
  • A. Münchau - Klinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
  • M. Westphal - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
  • W. Hamel - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.12.05

DOI: 10.3205/11dgnc090, URN: urn:nbn:de:0183-11dgnc0901

Published: April 28, 2011

© 2011 Buhmann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Head tremor may be associated with or the predominant symptom of patients with essential tremor (ET) or dystonia (DT). The globus pallidus internus (GPI) and the ventrolateral thalamus/subthalamic region ("VIM") represent competing targets for deep brain stimulation (DBS). The selection of the most promising target is often based on a symptom-driven decision, not only because the differential diagnosis between ET and DT is often difficult.

Methods: Fourteen patients (8 female; 3 classified as ET and 11 as DT) with predominant head tremor were evaluated. Electrodes were implantated bilaterally into the GPI (4) or VIM (9), and in one patient into both targets in a staged procedure (bilateral GPi stimulation followed by additional unilateral "VIM" stimulation) using microlectrode recording and test stimulation in the awake state or general anesthesia.

Results: In 13 patients, effective (>80–90%) tremor suppression was observed, and in one DT patient treated with GPI stimulation the response on the tremor was only modest. In one DT patient, dystonia had improved following GPI stimulation without affecting positional head tremor, which was then abolished by additional, unilateral "VIM" stimulation performed 12 months later. In one DT patient we observed an ongoing microlesioning effect over >6 months. In one patient, the tremor did not recur following switching off the stimulator for more than 6 months afterwards, whereby a slight tremor recurred without the necessity of reactivating DBS. Notably, an improvement in the cervical dystonia was also noted following "VIM" stimulation. In two patients with a follow-up of >1 year, the Toronto Western Spasmodic Torticollis Rating Scale part I (preoperative scores 8 and 7) was markedly improved (postoperative 2 and 1, respectively) with similar results in patients observed for shorter durations. The location of the active contacts was evaluated, which revealed that most active contacts for GPI and "VIM" stimulation were located within or below the posteroventral pallidum and in the subthalamic region, respectively.

Conclusions: Head tremor in ET and DT patients is efficiently suppressed by DBS applied to the GPI or "VIM." The "VIM" should also be considered in DT patients when tremor is the predominant symptom. Improvement of dystonia with "VIM" stimulation may result from modulation of pallidothalamic in addition to cerebellothalamic projections. Staged procedures addressing both targets may be required in individual cases to obtain adequate results.