Document Detail

Worsening essential tremor following deep brain stimulation: disease progression versus tolerance.
MedLine Citation:
PMID:  22344584     Owner:  NLM     Status:  Publisher    
A major concern regarding ventralis intermedius nucleus deep brain stimulation for essential tremor has been the loss of surgical efficacy over time in a minority of patients. Some experts have ascribed the worsening tremor to tolerance, while other evidence has suggested that disease progression may play a role. Suboptimal lead placement has also been reported to be a factor in worsening tremor following deep-brain stimulation; however, most authors consider this phenomenon to manifest within a few months of the actual surgery. We aimed to dissect the tolerance versus disease progression issue by analysing preoperative versus long-term post-surgical Fahn-Tolosa-Marin Tremor Rating Scale scores both on and off stimulation among 28 patients who underwent ventralis intermedius nucleus deep brain stimulation and 21 age-matched controls. Of the 28 patients in the treatment arm of the cohort, seven (25%) demonstrated evidence of tremor progression, and had a 34% increase in the tremor score off stimulation at the 36 month follow-up compared with a 32% increase among controls (P = 0.67). In one of the seven patients there was evidence of suboptimal lead placement given the lateral position of the lead, and the motor side effects during threshold testing. This patient demonstrated a loss of stimulation benefit between 24 and 36 months, which may have been more indicative of tolerance. The other six subjects (86%) maintained stimulation benefit throughout the follow-up period, despite worsening tremor off stimulation (at a comparable rate to that of controls), making disease progression the most likely explanation. The data suggest that deep brain stimulation tolerance may be over-reported in the literature, and that a tolerance versus disease progression work-up should include: examining the trend in off stimulation scores, accounting for image based lead locations, and during programming sessions checking for thresholds which may elicit clinical benefits and side effects.
Christopher G Favilla; David Ullman; Aparna Wagle Shukla; Kelly D Foote; Charles E Jacobson; Michael S Okun
Related Documents :
10809944 - Alcohol with xylocaine for treatment of eyelid dystonia.
15272644 - Antalgic effect and clinical tolerability of hyaluronic acid in patients with degenerat...
17219124 - Rate of epithelialisation and re-operations in corneal ulcers treated with amniotic mem...
16436824 - Low back pain: prediction of short-term outcome of facet joint injection with bone scin...
17881994 - Outcomes of three patients with intracranially invasive sino-orbital aspergillosis.
24550944 - Effects of carotid endarterectomy and carotid artery stenting on high-risk carotid sten...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-17
Journal Detail:
Title:  Brain : a journal of neurology     Volume:  -     ISSN:  1460-2156     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372537     Medline TA:  Brain     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Department of Neurology, University of Florida College of Medicine, Centre for Movement Disorders and Neurorestoration, 100 S Newell Drive, Gainesville, FL 32610, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

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

Previous Document:  Parkinson's disease, insulin resistance and novel agents of neuroprotection.
Next Document:  Altered neurotransmitter release, vesicle recycling and presynaptic structure in the pilocarpine mod...