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Bilateral thalamic deep brain stimulation: midline tremor control.

J D Putzke1, R J Uitti, A A Obwegeser

  • 1Department of Neurology, Mayo Clinic Jacksonville, FL 32224, USA.

Journal of Neurology, Neurosurgery, and Psychiatry
|April 19, 2005
PubMed
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Bilateral deep brain stimulation (DBS) significantly improves midline tremor in essential tremor patients. Adding bilateral stimulation provides further incremental benefits over unilateral therapy for head and voice tremor.

Area of Science:

  • Neurology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Essential tremor (ET) is a common neurological disorder characterized by involuntary shaking.
  • Midline tremor, affecting the head, voice, tongue, and trunk, can be particularly disabling in ET patients.
  • Current management strategies for ET often have limitations, necessitating advanced therapeutic options.

Purpose of the Study:

  • To evaluate the efficacy of bilateral deep brain stimulation (DBS) in managing midline tremor in patients with essential tremor.
  • To compare the effectiveness of bilateral DBS versus unilateral DBS for tremor control.

Main Methods:

  • A prospective study involving 22 patients with essential tremor undergoing staged, bilateral DBS.
  • Tremor severity was assessed using the Tremor Rating Scale at baseline, and at 1, 3, 12 months, and annually thereafter.

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  • Outcomes were compared between stimulation-off and stimulation-on states, as well as between unilateral and bilateral stimulation phases.

    • Main Results:

    • Bilateral DBS demonstrated significant improvement in midline tremor compared to baseline and stimulation-off conditions.
    • An average of 81% incremental improvement in midline tremor control was observed with bilateral stimulation compared to unilateral stimulation.
    • Head and voice tremor showed the most consistent positive response. Common side effects included dysarthria and disequilibrium, with dysarthria more frequent during bilateral stimulation.

    Conclusions:

    • Unilateral thalamic stimulation effectively reduces midline tremor in essential tremor.
    • Subsequent bilateral thalamic stimulation provides significant additional incremental improvement in midline tremor control.
    • Bilateral DBS is a viable and effective treatment option for refractory midline tremor in essential tremor, though careful monitoring for side effects is warranted.