Simultaneous thalamic and posterior subthalamic electrode insertion with single deep brain stimulation electrode for...

Area of Science:

• Neurosurgery
• Neurology
• Medical Devices

Background:

• Deep brain stimulation (DBS) is a treatment for essential tremor (ET).
• The optimal target location for DBS in ET remains debated.
• This study compared stimulation in the ventralis intermedius nucleus of thalamus (Vim) and posterior subthalamic area (PSA).

Purpose of the Study:

• To compare the efficacy of bilateral DBS targeting the Vim, PSA, or both (Vim + PSA) in patients with essential tremor (ET).
• To investigate individualized electrode placement for optimal DBS outcomes in ET.

Main Methods:

• Electrodes were implanted in the Vim and PSA in ten hemispheres of five ET patients.
• Patients were assessed for action tremor (postural and kinetic) preoperatively and at 6 months and 1 year postoperatively.
• Stimulation effects were evaluated for Vim, PSA, and Vim + PSA configurations.

Main Results:

• Significant reductions in postural and kinetic tremor scores were observed one year after surgery.
• Preoperative tremor scores averaged 1.9 for postural and 2.6 for kinetic tremor.
• Postoperative tremor scores decreased to 0.1 for postural and 0.6 for kinetic tremor.
• No statistically significant differences in tremor reduction were found between Vim, PSA, and Vim + PSA stimulation sites at 6 months and 1 year.

Conclusions:

• Individualized electrode placement based on patient response is crucial for DBS in ET.
• Ventralis intermedius nucleus of thalamus (Vim) and posterior subthalamic area (PSA) stimulation yield comparable benefits for essential tremor.
• The proposed surgical technique offers a potentially useful method for treating essential tremor with DBS.