Deep brain stimulation in benign tremulous parkinsonism

Area of Science:

• Neurosurgery
• Neurology
• Movement Disorders

Background:

• Benign tremulous parkinsonism (BTP) presents with prominent tremor and mild parkinsonism, often with limited response to levodopa.
• The pathophysiologic link between BTP and idiopathic Parkinson disease remains unclear.
• Deep brain stimulation (DBS) is a potential treatment for BTP, but prior experience is not documented.

Purpose of the Study:

• To evaluate the clinical outcomes of Deep Brain Stimulation (DBS) in patients with Benign Tremulous Parkinsonism (BTP).
• To assess surgical complications associated with DBS in BTP patients.
• To determine the efficacy of DBS for levodopa-refractory tremor in BTP.

Main Methods:

• Retrospective case series conducted at a tertiary care medical center.
• Fifteen patients (12 men, 3 women) with BTP underwent DBS for levodopa-refractory tremor.
• Outcomes measured included tremor status post-DBS, Fahn-Tolosa-Marin tremor scale scores, and adverse events.

Main Results:

• Patients received unilateral VIM (n=8), bilateral VIM (n=4), or bilateral STN (n=3) DBS.
• At a median 4-year follow-up, 7 patients were tremor-free, 6 had trace tremor, and 2 showed improvement.
• Significant reduction in Fahn-Tolosa-Marin tremor scale scores from a median of 17 to 1 was observed.
• No adverse events were reported post-surgery.

Conclusions:

• Deep brain stimulation (DBS) is effective for medically refractory tremor in Benign Tremulous Parkinsonism (BTP).
• Both VIM and STN targets demonstrate efficacy for BTP tremor.
• Further research is needed to assess long-term response durability and compare surgical targets.