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Comparing two deep brain stimulation leads to one in refractory tremor.

R Mehanna1, A G Machado, S Oravivattanakul

  • 1University of Texas Health Science Center, Houston, TX, USA, raja.mehanna@uth.tmc.edu.

Cerebellum (London, England)
|February 25, 2014
PubMed
Summary

Adding a second deep brain stimulation (DBS) lead may improve refractory tremor in some patients when the initial lead in the ventralis intermedialis nucleus (Vim) is insufficient. Four out of five patients showed tremor reduction in a double-blind study.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Movement Disorders

Background:

  • Medication-refractory tremor often requires advanced interventions like deep brain stimulation (DBS).
  • The ventralis intermedialis nucleus (Vim) of the thalamus is a common DBS target for tremor.
  • Some patients do not achieve satisfactory tremor control with standard Vim DBS, necessitating alternative strategies.

Purpose of the Study:

  • To evaluate the efficacy of a second ipsilateral DBS lead in patients with tremor refractory to standard Vim DBS.
  • To provide a double-blind assessment of tremor reduction with additional DBS lead placement.

Main Methods:

  • A double-blind study involving five patients with refractory tremor.
  • Tremor was assessed using a videotaped tremor rating scale (TRS) under four conditions: both leads OFF, Vim ON/2nd lead OFF, Vim OFF/2nd lead ON, and both leads ON.
  • Statistical analysis (paired t-test) compared outcomes between stimulation conditions.

Main Results:

  • Four out of five patients demonstrated objective tremor improvement (17-60%) with the addition of a second DBS lead compared to Vim stimulation alone.
  • While individual improvements were noted, the overall group results did not reach statistical significance.
  • Results were consistent across different tremor rating scales and patient subgroups (multiple sclerosis and essential tremor).

Conclusions:

  • The addition of a second DBS lead may offer objective tremor improvement in select patients refractory to standard Vim DBS.
  • The lack of statistical significance in this small, heterogeneous sample highlights the need for larger studies.
  • Further research is warranted to confirm the efficacy and identify optimal targets for a second DBS lead in refractory tremor cases.