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Reoperation after failed deep brain stimulation for essential tremor.

Patric Blomstedt1, Peter Lindvall, Jan Linder

  • 1Department of Pharmacology and Clinical Neuroscience, Section of Neurosurgery, Umeå University, Umeå, Sweden. patric.blomstedt@neuro.umu.se

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Summary

Deep brain stimulation (DBS) in the caudal zona incerta (cZi) improved essential tremor when ventral intermediate nucleus (Vim) DBS failed. While cZi DBS was more effective, some tremor persisted, especially in patients with late Vim DBS failure.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Medical Devices

Background:

  • Essential tremor (ET) is a common neurological disorder.
  • Deep brain stimulation (DBS) is a treatment option for refractory ET.
  • Ventral intermediate nucleus (Vim) DBS is a standard treatment for ET.

Observation:

  • This study evaluated reoperation with DBS in the caudal zona incerta (cZi) for patients with failed Vim DBS.
  • Five patients with essential tremor and prior failed Vim DBS underwent cZi DBS reoperation.
  • Analysis focused on tremor reduction and functional improvement post-reoperation.

Findings:

  • Reoperation with cZi DBS resulted in a 57% improvement in tremor and hand function, compared to 25% with prior Vim DBS.
  • Two patients experienced early Vim DBS failure, while three had late failure after initial success.
  • Even with cZi DBS, a considerable residual tremor remained in some patients, particularly those with late Vim DBS failure.

Implications:

  • Caudal zona incerta (cZi) DBS may be a viable alternative for essential tremor patients with failed Vim DBS.
  • The effectiveness of cZi DBS might be limited in cases of late-onset Vim DBS failure.
  • Further research with larger cohorts is needed to confirm the long-term efficacy and optimal targeting for cZi DBS in essential tremor.