Thalamic short pulse stimulation diminishes adverse effects in essential tremor patients

TY - JOUR

T1 - Thalamic short pulse stimulation diminishes adverse effects in essential tremor patients

AU - Choe, Chi-Un

AU - Hidding, Ute

AU - Schaper, Miriam

AU - Gulberti, Alessandro

AU - Köppen, Johannes

AU - Buhmann, Carsten

AU - Gerloff, Christian

AU - Moll, Christian K E

AU - Hamel, Wolfgang

AU - Pötter-Nerger, Monika

N1 - © 2018 American Academy of Neurology.

PY - 2018/8/21

Y1 - 2018/8/21

N2 - OBJECTIVE: To investigate the effect of directional current steering and short pulse stimulation in the ventral intermediate thalamic nucleus (VIM) on stimulation-induced side effects in patients with essential tremor.METHODS: We recruited 8 patients with essential tremor in a stable postoperative condition (>3 months after electrode implantation of deep brain stimulation [DBS] electrodes) with segmented contacts implanted in the VIM. Tremor severity on acute stimulation was assessed by the Fahn-Tolosa-Marin Tremor Rating Scale. Cerebellar impairment was evaluated with the International Cooperative Ataxia Rating Scale. Patients rated paresthesia intensity with a visual analog scale.RESULTS: In all patients, tremor was reduced to the same extent by VIM stimulation regardless of pulse width using energy dose-equivalent amplitudes. Short pulse stimulation diminished stimulation-induced ataxia of the upper extremities and paresthesia compared with conventional parameters. Directional steering with monopolar stimulation of single segments successfully suppressed tremor but also induced ataxia. No differences in adverse effects were found between single-segment stimulation conditions.CONCLUSION: These proof-of-principle findings provide evidence that acute short pulse stimulation is superior to directional steering in the subthalamic area to decrease stimulation-induced side effects while preserving tremor suppression effects in patients with tremor.CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with tremor with thalamic DBS, acute short pulse stimulation reduces adverse effects, while directional steering does not provide a generalizable benefit regarding adverse effects.

AB - OBJECTIVE: To investigate the effect of directional current steering and short pulse stimulation in the ventral intermediate thalamic nucleus (VIM) on stimulation-induced side effects in patients with essential tremor.METHODS: We recruited 8 patients with essential tremor in a stable postoperative condition (>3 months after electrode implantation of deep brain stimulation [DBS] electrodes) with segmented contacts implanted in the VIM. Tremor severity on acute stimulation was assessed by the Fahn-Tolosa-Marin Tremor Rating Scale. Cerebellar impairment was evaluated with the International Cooperative Ataxia Rating Scale. Patients rated paresthesia intensity with a visual analog scale.RESULTS: In all patients, tremor was reduced to the same extent by VIM stimulation regardless of pulse width using energy dose-equivalent amplitudes. Short pulse stimulation diminished stimulation-induced ataxia of the upper extremities and paresthesia compared with conventional parameters. Directional steering with monopolar stimulation of single segments successfully suppressed tremor but also induced ataxia. No differences in adverse effects were found between single-segment stimulation conditions.CONCLUSION: These proof-of-principle findings provide evidence that acute short pulse stimulation is superior to directional steering in the subthalamic area to decrease stimulation-induced side effects while preserving tremor suppression effects in patients with tremor.CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with tremor with thalamic DBS, acute short pulse stimulation reduces adverse effects, while directional steering does not provide a generalizable benefit regarding adverse effects.

KW - Journal Article

U2 - 10.1212/WNL.0000000000006033

DO - 10.1212/WNL.0000000000006033

M3 - SCORING: Journal article

C2 - 30045955

VL - 91

SP - e704-e713

JO - NEUROLOGY

JF - NEUROLOGY

SN - 0028-3878

IS - 8

ER -