Document Detail

Quantitative and qualitative outcome measures after thalamic deep brain stimulation to treat disabling tremors.
MedLine Citation:
PMID:  11220369     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We studied outcome measures after unilateral and bilateral thalamic stimulation to treat disabling tremor resulting from essential tremor and Parkinson's disease. The surgical technique, qualitative and quantitative tremor assessments, stimulation parameters, locations of active electrodes, complications, and side effects are described and analyzed. METHODS: Forty-one patients with essential tremor or Parkinson's disease underwent implantation of 56 thalamic stimulators. Preoperative qualitative and quantitative tremor measurements were compared with those obtained after unilateral and bilateral surgery, with activated and deactivated stimulators. Stimulation parameters and stimulation-related side effects were recorded, and outcome measures were statistically analyzed. RESULTS: Qualitative measurements demonstrated significant improvement of contralateral upper-limb (P < 0.001), lower-limb (P < 0.01), and midline (P < 0.001) tremors after unilateral surgery. Ipsilateral arm tremor also improved (P < 0.01). No differences were observed with the Purdue pegboard task. Quantitative accelerometer measurements were correlated with qualitative assessments and confirmed improvements in contralateral resting (P < 0.001) and postural (P < 0.01) tremors and ipsilateral postural tremor (P < 0.05). Activities of daily living improved after unilateral surgery (P < 0.001) and additionally after bilateral surgery (P < 0.05). Adjustments of the pulse generator were required more frequently for tremor control than for amelioration of side effects. Bilateral thalamic stimulation caused more dysarthria and dysequilibrium than did unilateral stimulation. Stimulation-related side effects were reversible for all patients. Stimulation parameters did not change significantly with time. A significantly lower voltage and greater pulse width were used for patients with bilateral implants. CONCLUSION: Unilateral thalamic stimulation and bilateral thalamic stimulation are safe and effective procedures that produce qualitative and quantitative improvements in resting, postural, and kinetic tremor. Thalamic stimulation-related side effects are mild and reversible.
A A Obwegeser; R J Uitti; R J Witte; J A Lucas; M F Turk; R E Wharen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  48     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-02-23     Completed Date:  2001-05-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  274-81; discussion 281-4     Citation Subset:  IM    
Department of Neurosurgery, Mayo Clinic Jacksonville, Florida 32224, USA.
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MeSH Terms
Activities of Daily Living
Electric Stimulation Therapy* / adverse effects
Middle Aged
Outcome Assessment (Health Care)
Parkinson Disease / physiopathology,  surgery,  therapy
Postoperative Complications / surgery
Thalamus / physiopathology*
Tremor / physiopathology*,  surgery,  therapy*

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