+ Translate

Worsening essential tremor following deep brain stimulation: disease progression versus tolerance

, : Worsening essential tremor following deep brain stimulation: disease progression versus tolerance. Brain 135(Pt 5): 1455-1462

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 = .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.

(PDF same-day service: $19.90)

Order PDF Full Text


Click here to order any other PDF Full Text

Accession: 036392089

PMID: 22344584

DOI: 10.1093/brain/aws026

PDF Full Text: Submit

Submit PDF Full Text

No spam - Every submission is manually reviewed

Due to poor quality, we do not accept files from Researchgate

Submitted PDF Full Texts will always be free for everyone
(We only charge for PDFs that we need to acquire)

Select a PDF file:

Other references

Lange, Jm, 1977: Saving energy by regaining heat on dairy farms. Landbouwmechanisatie 28 (7) 813-816

Hasebe K.; Hikima S.; Yoshida H., 1991: Determination of l lactate by differential pulse polarography with covalently immobilized enzyme on chitopearl. The covalent bonding of L-lactate oxidase (no E.C.) to cross-linked copolymers of chitosan (Chitopearl) using the glutaraldehyde method is described and applied to the determination of L-lactate in serums of diseased and normal animals. The biorea...

Perez-D'-Angello, V., 1974: Note on the nest of Hypodynerus porteri (Hymenoptera, Eumenidae). Revista Chilena de entomologia: 147

McNamara, A.; Tegenthoff, M.; Dinse, H.; Büchel, C.; Binkofski, F.; Ragert, P., 2007: Increased functional connectivity is crucial for learning novel muscle synergies. To gain efficiency in performance of a novel complex movement, we must learn to coordinate the action of the pertinent muscle groups. We used functional magnetic resonance imaging (fMRI) to investigate the mechanisms of learning a novel synergic...

Logan, David C.; Domergue, Odile; Teyssendier De La Serve, Bernard; Rossignol, Michel, 1997: A new family of plasma membrane polypeptides differentially regulated during plant development. Two cDNAs encoding polypeptides identified in a tobacco leaf plasma membrane fraction prepared by phase partitioning were cloned. The deduced polypeptides, P16 and P17, exhibit a striking primary structure, similar to that of P19, a previously clo...

Bell P.D.; Krause A.; Franco M., 1988: Macula densa cytosolic calcium concentration during changes in luminal fluid osmolality. Kidney International 33(1): 150

Parslow, J. L. F.; Carter, M. J., 1965: Bobolink in the Isles of Scilly a bird new to Great Britain and Ireland. British Birds, 58: 208-214

Dowben, Robert M.; Curry, Willie M.; Naderson, Kenning M.; Zak, Radovan, 1965: Studies on actin-azomercurial complexes. G-Actin free of tropomyosin reacts with six equivalents of 4-(p-hydroxybenzeneazo)phenylmercuri-acetate. Two thiol groups react rapidly and the adduct polymerizes to F-actin. Two more thiol groups react rapidly but the adduct loses bound ATP slowl...

Sainsbury, Dwb, 1988: Broiler chicken. Management and welfare of farm animals: 232

Bove, Marco; Grattarola, Massimo; Martinoia, Sergio; Verreschi, Giovanni, 1995: Interfacing cultured neurons to planar substrate microelectrodes: Characterization of the neuron-to-microelectrode junction. This paper focuses on the characterization of the bioelectrochemical interface that develops whenever neurons are cultured directly on top of planar arrays of noble metal microelectrodes. The characterization is based on the equivalent circuit ana...