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Disruption in proprioception from long-term thalamic deep brain stimulation: a pilot study.

Jennifer A Semrau1, Troy M Herter2, Zelma H Kiss1

  • 1Hotchkiss Brain Institute, University of Calgary Calgary, AB, Canada ; Department of Clinical Neurosciences, University of Calgary Calgary, AB, Canada.

Frontiers in Human Neuroscience
|May 19, 2015
PubMed
Summary

Long-term deep brain stimulation (DBS) for tremor may cause lasting proprioceptive deficits. This may explain gait issues observed after Vim nucleus DBS.

Keywords:
deep brain stimulation (DBS)kinesthesiaposition senseproprioceptionsensorimotortremor

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Area of Science:

  • Neuroscience
  • Movement Disorders
  • Neurosurgery

Background:

  • Deep brain stimulation (DBS) is a common treatment for tremor, targeting the thalamus's ventrointermedius (Vim) nucleus.
  • While DBS is generally reversible, long-term effects on proprioception, the sense of limb position and movement, are not well understood.
  • Gait disturbances are noted with bilateral Vim DBS, suggesting potential impacts on sensory processing.

Purpose of the Study:

  • To investigate whether surgical implantation or chronic stimulation of the Vim nucleus via DBS causes proprioceptive deficits in the upper limb.
  • To differentiate between deficits caused by tremor itself, surgical implantation, and stimulation parameters.

Main Methods:

  • Two groups of tremor patients were assessed using a robotic exoskeleton for proprioception (kinaesthesia, position sense) and motor function.
  • The 'Surgery' group was tested before and after Vim DBS implantation (pre-stimulation).
  • The 'Stim' group was tested with chronic Vim DBS ON and OFF, comparing short-term (ST-stim) and long-term (LT-stim) stimulation durations.

Main Results:

  • No proprioceptive deficits were found before or after DBS implantation in the 'Surgery' group.
  • Patients with long-term stimulation (LT-stim, 3-10 years) showed significant proprioceptive deficits (position sense variability, reduced workspace, directional errors, underestimated speed) regardless of stimulation status.
  • These deficits were not observed in patients with short-term stimulation (ST-stim, 0.5-2 years).

Conclusions:

  • Chronic, long-term Vim DBS may lead to persistent proprioceptive processing deficits in the upper limb.
  • These deficits might result from irreversible neuroplastic changes in the Vim nucleus or its network connections.
  • Findings may elucidate the mechanisms behind gait disturbances observed in patients receiving long-term Vim DBS.