Dual target deep brain stimulation for complex essential and dystonic tremor - A 5-year follow up.

Shepherd, Hilary, Heartshorne, Rosie, Osman-Farah, Jibril and Macerollo, Antonella ORCID: 0000-0003-4322-2706 (2024) Dual target deep brain stimulation for complex essential and dystonic tremor - A 5-year follow up. Journal of the neurological sciences, 457. p. 122887.

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Abstract

<h4>Background</h4>Essential tremor (ET) is characterized by action tremor of the upper limbs, head tremor and voice tremor. Dystonic tremor (DT) is produced by muscle contractions in a body affected by dystonia. Deep brain stimulation (DBS) of ventral intermediate nucleus of the thalamus (VIM) is the most well-known advanced treatment for medication-refractory tremor. However, decline in efficacy overtime has led to explore other targets. This study aimed to measure the efficacy of bilateral dual targeting ViM/caudal Zona Incerta (cZI) stimulation on tremor control. A secondary aim was to evaluate if there was a difference in the efficacy between ET and DT.<h4>Methods</h4>36 patients were retrospectively recruited at the Walton NHS Foundation Trust, Liverpool, UK. Patients were assessed pre-operatively, and then at 1-year, 3-years, and 5-years post-operatively with the following scales: Fahn-Tolosa-Marin tremor rating (FTMTR) scale, EuroQol-5D, and Hospital Anxiety and Depression Scale.<h4>Results</h4>Bilateral ViM-cZI DBS significantly improved overall tremor score by 45.1% from baseline to 3-years post-operatively (p < 0.001). It continued to show improvement in overall FTMTR score by 30.7% at 5-years but this failed to meet significance. However, there was no significant improvement of mood or quality of life (QoL) scores. ET group on average showed a significant better clinical outcome compared to the DT group (p > 0.001).<h4>Conclusions</h4>Our study found that bilateral ViM-cZI DBS treatment had a favourable effect on motor symptoms sustained over the 5-years in tremor patients, especially in ET group. There was limited effect on mood and QoL with similar trends in outcomes for both tremor types.

Item Type:	Article
Uncontrolled Keywords:	Humans, Essential Tremor, Heredodegenerative Disorders, Nervous System, Dystonia, Tremor, Treatment Outcome, Deep Brain Stimulation, Retrospective Studies, Follow-Up Studies, Quality of Life
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	05 Feb 2024 08:51
Last Modified:	01 Mar 2024 15:35
DOI:	10.1016/j.jns.2024.122887
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3178378