Unilateral thalamic deep brain stimulation in essential tremor demonstrates long-term ipsilateral effects |
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Authors: | Zhongxing Peng-Chen Takashi Morishita David Vaillancourt Chris Favilla Kelly D. Foote Michael S. Okun Aparna Wagle Shukla |
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Affiliation: | 1. Department of Neurology, University of Florida, Movement Disorders Center, Gainesville, FL, USA;2. University for Development, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago, Chile;3. Department of Neurosurgery, University of Florida, Gainesville, FL, USA;4. Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA |
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Abstract: | IntroductionDeep Brain Stimulation (DBS) of thalamus in essential tremor (ET) is effective for the treatment of contralateral tremors. Bilateral DBS controls tremors on both sides but is associated with increased morbidity and risks. We evaluated if unilateral surgery had ipsilateral benefits on tremors and thus could be a potentially safer alternative to bilateral DBS.MethodsMedication refractory ET patients undergoing unilateral thalamic DBS were included and longitudinally followed. Tremor rating scale was used to record total motor, arm tremor and activities of daily living (ADL) scores at baseline, six months and at last visit (three or more years after surgery). Postoperative scores were recorded with DBS turned OFF and ON.ResultsTwenty-two patients with a mean follow-up 3.4 ± 0.14 years were enrolled. When baseline scores were compared to scores with the DBS turned ON, significant improvements were noted in total tremor (40%), ADL (67%) and arm tremor scores both on the ipsilateral and the contralateral side at six months and at the last visit of follow-up (all p < 0.05). Ipsilateral arm tremor (~56%) improvements were milder compared to the contralateral side (~73%) tremors.ConclusionUnilateral thalamic DBS in ET demonstrates significant long-term benefits for ipsilateral arm tremors and can be offered to higher risk and to select patients. |
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Keywords: | DBS Thalamus Essential tremors |
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