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Brain Atrophy Following Deep Brain Stimulation: Management of a Moving Target
Shannon Y Chiu1, Wissam Deeb1, Pamela Zeilman1
1Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, US.
Clinical Vignette:
A 51-year-old man with essential tremor (ET) had bilateral ventralis intermedius nucleus deep brain stimulation (VIM-DBS) placed to address refractory tremor. Despite well-placed DBS leads and adequate tremor response, he subsequently experienced worsening. Re-programming of the device and reconfirming the electrical thresholds for benefits and side effects were both performed. Six years following DBS implantation, repeat imaging revealed brain atrophy and a measured lead position change with a coincident change in clinical response.
Clinical Dilemma:
What do we know about brain atrophy affecting lead placement and long-term DBS effectiveness? What are the potential strategies to combat narrowed therapeutic thresholds and to maximize DBS therapeutic benefit?
Clinical Solution:
Decreasing the electrical field of stimulation and programming in a bipolar configuration are strategies to provide symptomatic tremor control and to minimize stimulation-induced side effects.
Gaps In Knowledge:
Currently, effects of brain atrophy, and factors underpinning emergence of side effects and/or loss of benefit in chronic VIM-DBS remain largely unexplored.
