Thalamotomy as a Treatment Option for Tremor after Ineffective Deep Brain Stimulation

Background: As the number of deep brain stimulation (DBS) surgeries increases, complications from malpositioned electrodes, tolerance to stimulation and loss of efficacy have also increased. Our objective was to assess thalamotomy as a salvage treatment option after ineffective DBS. Methods: A retrospective chart analysis of patients who underwent ipsilateral stereotactic thalamotomy after an ineffective ventrointermediate nucleus DBS procedure was undertaken. Patient outcome was based on follow-up visit chart notes, and a nonvalidated patient telephone questionnaire to assess patients’ perception of tremor and functional ability after thalamotomy. Results: Six patients with essential tremor and 1 with tremor-predominant Parkinson’s disease met our inclusion criteria. Thalamotomies were undertaken for ineffective DBS due to dysarthria and paresthesias with programming in 2 patients, tremor that failed to respond to increased DBS despite a lack of side effects in 2 patients, malpositioned electrode in 2 patients, and sudden loss of DBS efficacy following eye surgery in 1 patient. Following thalamotomy, 3 patients reported improvement in symptoms and function, 3 patients reported improvement in symptoms that were not reflected in functional improvement, and 1 patient reported no improvement in symptoms or function. Conclusion: Thalamotomy may provide a viable salvage solution in patients who fail to respond to DBS due to complications such as malpositioned electrodes, tolerance to stimulation or loss of efficacy.

[1]  J. Lou,et al.  A randomized comparison of thalamic stimulation and lesion on self-paced finger movement in essential tremor , 2009, Neuroscience Letters.

[2]  P. Konrad,et al.  Confined Stimulation Using Dual Thalamic Deep Brain Stimulation Leads Rescues Refractory Essential Tremor: Report of Three Cases , 2009, Stereotactic and Functional Neurosurgery.

[3]  R. Bakay,et al.  Factors involved in long-term efficacy of deep brain stimulation of the thalamus for essential tremor. , 2008, Journal of neurosurgery.

[4]  Atchar Sudhyadhom,et al.  REOPERATION FOR SUBOPTIMAL OUTCOMES AFTER DEEP BRAIN STIMULATION SURGERY , 2008, Neurosurgery.

[5]  J. Speelman,et al.  Long‐term follow‐up of thalamic stimulation versus thalamotomy for tremor suppression , 2008, Movement disorders : official journal of the Movement Disorder Society.

[6]  J. Jankovic,et al.  Long-term evaluation of deep brain stimulation of the thalamus. , 2006, Journal of neurosurgery.

[7]  M. Okun,et al.  Dual Electrode Thalamic Deep Brain Stimulation for the Treatment of Posttraumatic and Multiple Sclerosis Tremor , 2006, Neurosurgery.

[8]  W. Ondo,et al.  The North American Survey of Placement and Adjustment Strategies for Deep Brain Stimulation , 2005, Stereotactic and Functional Neurosurgery.

[9]  Z. Kiss,et al.  Nursing time to program and assess deep brain stimulators in movement disorder patients. , 2005, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[10]  M. Okun,et al.  Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers. , 2005, Archives of neurology.

[11]  Gregory F. Molnar,et al.  Changes in cortical excitability with thalamic deep brain stimulation , 2005, Neurology.

[12]  A. Strafella,et al.  The impact of ventrolateral thalamotomy on high-frequency components of tremor , 2005, Clinical Neurophysiology.

[13]  M. Okun,et al.  Ventralis Intermedius plus Ventralis Oralis Anterior and Posterior Deep Brain Stimulation for Posttraumatic Holmes Tremor: Two Leads May Be Better than One: Technical Note , 2005, Neurosurgery.

[14]  Aviva Abosch,et al.  Thalamic Deep Brain Stimulation for Essential Tremor: Relation of Lead Location to Outcome , 2004, Neurosurgery.

[15]  A. Samii,et al.  Mechanical failure of the electrode wire in deep brain stimulation. , 2004, Parkinsonism & related disorders.

[16]  M. Vérin,et al.  Staged lesions through implanted deep brain stimulating electrodes: A new surgical procedure for treating tremor or dyskinesias , 2003, Movement disorders : official journal of the Movement Disorder Society.

[17]  Marwan Hariz,et al.  Long‐term efficacy of thalamic deep brain stimulation for tremor: Double‐blind assessments , 2003, Movement disorders : official journal of the Movement Disorder Society.

[18]  Aviva Abosch,et al.  Long-term Hardware-related Complications of Deep Brain Stimulation , 2002, Neurosurgery.

[19]  Tipu Aziz,et al.  Hardware‐Related problems of deep brain stimulation , 2002, Movement disorders : official journal of the Movement Disorder Society.

[20]  A. Lang,et al.  Deep Brain Stimulator Electrodes Used for Lesioning: Proof of Principle , 2001, Neurosurgery.

[21]  J. Moringlane,et al.  Thalamic stimulation for essential tremor activates motor and deactivates vestibular cortex , 2001, Neurology.

[22]  K. Lyons,et al.  Long‐term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor , 2001, Movement disorders : official journal of the Movement Disorder Society.

[23]  M. Hariz,et al.  Tolerance and Tremor Rebound following Long-Term Chronic Thalamic Stimulation for Parkinsonian and Essential Tremor , 2000, Stereotactic and Functional Neurosurgery.

[24]  P. Bossuyt,et al.  A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. , 2000, The New England journal of medicine.

[25]  Patricia Limousin,et al.  Chronic Electrical Stimulation of the Ventralis Intermedius Nucleus of the Thalamus and of Other Nuclei as a Treatment for Parkinson's Disease , 1999 .

[26]  E. Louis,et al.  How common is the most common adult movement disorder? Estimates of the prevalence of essential tremor throughout the world , 1998, Movement disorders : official journal of the Movement Disorder Society.

[27]  A. Lang,et al.  High‐frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor , 1997, Annals of neurology.

[28]  A. Benabid,et al.  Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. , 1996, Journal of neurosurgery.

[29]  J. Jankovic,et al.  Outcome after stereotactic thalamotomy for parkinsonian, essential, and other types of tremor. , 1995, Neurosurgery.

[30]  G. Percheron,et al.  Long‐term thalamic stimulation in Parkinson's disease , 1994, Neurology.

[31]  W. Koller,et al.  The relationship of essential tremor to other movement disorders: Report on 678 patients , 1994, Annals of neurology.

[32]  Richard S. J. Frackowiak,et al.  Thalamic stimulation and suppression of parkinsonian tremor. Evidence of a cerebellar deactivation using positron emission tomography. , 1993, Brain : a journal of neurology.

[33]  M. S. Goldman,et al.  The symptomatic and functional outcome of stereotactic thalamotomy for medically intractable essential tremor. , 1992, Journal of neurosurgery.

[34]  A. Benabid,et al.  Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus , 1991, The Lancet.

[35]  T Shibazaki,et al.  Long-term follow-up results of selective VIM-thalamotomy. , 1986, Journal of neurosurgery.

[36]  K J Burchiel,et al.  Thalamotomy for movement disorders. , 1995, Neurosurgery clinics of North America.

[37]  F. Mundinger,et al.  Long-term results of stereotaxy in the treatment of essential tremor. , 1990, Stereotactic and functional neurosurgery.

[38]  A. Benabid,et al.  Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. , 1987, Applied neurophysiology.

[39]  R. Angel,et al.  Action tremor and thalamotomy. , 1969, Electroencephalography and clinical neurophysiology.