Document Detail

Brain penetration effects of microelectrodes and deep brain stimulation leads in ventral intermediate nucleus stimulation for essential tremor.
MedLine Citation:
PMID:  19663554     Owner:  NLM     Status:  MEDLINE    
OBJECT: Microelectrode recording (MER) and macrostimulation (test stimulation) are used to refine the optimal deep brain stimulation (DBS) lead placement within the operative setting. It is well known that there can be a microlesion effect with microelectrode trajectories and DBS insertion. The aim of this study was to determine the impact of intraoperative MER and lead placement on tremor severity in a cohort of patients with essential tremor.
METHODS: Consecutive patients with essential tremor undergoing unilateral DBS (ventral intermediate nucleus stimulation) for medication-refractory tremor were evaluated. Tremor severity was measured at 5 time points utilizing a modified Tremor Rating Scale: 1) immediately before MER; 2) immediately after MER; 3) immediately after lead implantation; 4) 6 months after DBS implantation in the off-DBS condition; and 5) 6 months after implantation in the on-DBS condition. To investigate the impact of the MER and DBS lead placement, Wilcoxon signed-rank tests were applied to test changes in tremor severity scores over the surgical course. In addition, a generalized linear mixed model including factors that potentially influenced the impact of the microlesion was also used for analysis.
RESULTS: Nineteen patients were evaluated. Improvement was noted in the total modified Tremor Rating Scale, postural, and action tremor scores (p < 0.05) as a result of MER and DBS lead placement. The improvements observed following lead placement were similar in magnitude to what was observed in the chronically programmed clinic setting parameters at 6 months after lead implantation. Improvement in tremor severity was maintained over time even in the off-DBS condition at 6 months, which was supportive of a prolonged microlesion effect. The number of macrostimulation passes, the number of MER passes, and disease duration were not related to the change in tremor severity score over time.
CONCLUSIONS: Immediate improvement in postural and intention tremors may result from MER and DBS lead placement in patients undergoing DBS for essential tremor. This improvement could be a predictor of successful DBS lead placement at 6 months. Clinicians rating patients in the operating room should be aware of these effects and should consider using rating scales before and after lead placement to take these effects into account when evaluating outcome in and out of the operating room.
Takashi Morishita; Kelly D Foote; Samuel S Wu; Charles E Jacobson; Ramon L Rodriguez; Ihtsham U Haq; Mustafa S Siddiqui; Irene A Malaty; Christopher J Hass; Michael S Okun
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  112     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-02     Completed Date:  2010-04-08     Revised Date:  2013-09-10    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  491-6     Citation Subset:  AIM; IM    
Department of Neurology, Movement Disorders Center, University of Florida, McKnight Brain Institute, Gainesville, Florida 32610, USA.
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MeSH Terms
Brain / physiopathology*
Cohort Studies
Deep Brain Stimulation / instrumentation*
Electrodes, Implanted
Essential Tremor / physiopathology*,  therapy*
Linear Models
Middle Aged
Neurosurgical Procedures / instrumentation,  methods
Reproducibility of Results
Time Factors
Treatment Outcome
Grant Support
Erratum In:
J Neurosurg. 2010 Mar;112(3):689

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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