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- Blomstedt, Patric, et al.
(författare)
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Deep brain stimulation of the posterior subthalamic area in the treatment of tremor
- 2009
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 151:1, s. 31-36
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Several studies have described lesional therapy in the posterior subthalamic area (PSA) in the treatment of various movement disorders. Recently, some publications have illustrated the effect of deep brain stimulation (DBS) in this area in patients with Parkinson's disease, essential tremor, MS-tremor, and other forms of tremor. Even though the clinical series is small, the reported benefits prompted us to explore DBS in this area in the treatment of tremor. METHOD: Five patients with tremor were operated using unilateral DBS of the PSA. Two patients had dystonic tremor, one primary writing tremor, one cerebellar tremor and the other neuropathic tremor. All patients were assessed before and 1 year after surgery using items 5 and 6 (tremor of the upper extremity), 11-14 (hand function), and when appropriate item 10 (handwriting) from the essential tremor rating scale. FINDINGS: The mean improvement on stimulation after 1 year was 87%. A pronounced and sustained microlesional effect was seen in several of the patients, and while the mean improvement off stimulation was 56% the reduction in the three patients with the most pronounced effect was 89%. The two patients with dystonic tremor did also become free of the dystonic symptoms and pain in the treated arm. No severe complication occurred. CONCLUSIONS: DBS of the PSA in this small group of patients had an excellent effect on the different forms of tremor, except for the neuropathic tremor where the effect was moderate. These preliminary results suggest PSA to be an effective target for the treatment of various forms of tremor. Further studies concerning indications, safety and efficacy of DBS in the posterior subthalamic area are required.
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| 2. |
- Blomstedt, Patric, et al.
(författare)
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Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor
- 2011
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Ingår i: Acta Neurochirurgica. - Wien : Springer. - 0001-6268 .- 0942-0940. ; 153:12, s. 2329-2335
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Tidskriftsartikel (refereegranskat)abstract
- Background: Deep brain stimulation (DBS) is an effective treatment for essential tremor (ET). Currently the ventrolateral thalamus is the target of choice, but the posterior subthalamic area (PSA), including the caudal zona incerta (cZi), has demonstrated promising results, and the subthalamic nucleus (STN) has been suggested as a third alternative. The objective of the current study was to evaluate the effect of STN DBS in ET and to compare this to cZi DBS. Methods: Four patients with ET were implanted with two ipsilateral electrodes, one in the STN and one in the cZi. All contacts were evaluated concerning the acute effect on tremor, and the effect of chronic DBS in either target was analyzed. Results: STN and cZi both proved to be potent targets for DBS in ET. DBS in the cZi was more efficient, since the same degree of tremor reduction could here be achieved at lower energy consumption. Three patients became tremor-free in the treated hand with either STN or cZi DBS, while the fourth had a minor residual tremor after stimulation in either target. Conclusion: In this limited material, STN DBS was demonstrated to be an efficient treatment for ET, even though cZi DBS was more efficient. The STN may be an alternative target in the treatment of ET, pending further investigations to decide on the relative merits of the different targets.
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| 3. |
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| 4. |
- Naesström, Matilda, et al.
(författare)
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Distribution of electric field in patients with obsessive compulsive disorder treated with deep brain stimulation of the bed nucleus of stria terminalis
- 2022
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Ingår i: Acta Neurochirurgica. - : Springer. - 0001-6268 .- 0942-0940. ; 164, s. 193-202
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Tidskriftsartikel (refereegranskat)abstract
- Background: Deep brain stimulation (DBS) is being investigated as a treatment for therapy-refractory obsessive-compulsive disorder (OCD). Many different brain targets are being trialled. Several of these targets such as the ventral striatum (including the nucleus accumbens (NAc)), the ventral capsule, the inferior thalamic peduncle and the bed nucleus of stria terminalis (BNST)) belong to the same network, are anatomically very close to one another, or even overlap. Data is still missing on how various stimulation parameters in a given target will affect surrounding anatomical areas and impact the clinical outcome of DBS.Methods: In a pilot study of eleven participants with DBS of the BNST, we investigate through patient-specific simulation of electric field, which anatomical areas are affected by the electric field, and if this can be related to the clinical results. Our study, combined individual patient’s stimulation parameters at 12 and 24-months follow-up with image data from the preoperative MRI and postoperative CT. These data were used to calculate the distribution of electric field and create individual anatomical models of the field of stimulation.Results: The individual electric stimulation fields by stimulation in the BNST were similar at both the 12 and 24-months follow up, involving mainly anterior limb of the internal capsule (ALIC), genu of the internal capsule (IC), BNST, fornix, anteromedial globus pallidus externa (GPe) and the anterior commissure. A statistical significant correlation (p < 0.05) between clinical effect measured by the Yale-Brown Obsessive Compulsive Scale and stimulation was found at the 12-month follow up in the ventral ALIC and anteromedial GPe.Conclusions: Many of the targets under investigation for OCD are in anatomical proximity. As seen in our study, off-target effects are overlapping. Therefore, DBS in the region of ALIC, NAc and BNST may perhaps be considered to be stimulation of the same target.
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| 5. |
- Philipson, Johanna, et al.
(författare)
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Deep brain stimulation in the ALIC-BNST region targeting the bed nucleus of stria terminalis in patients with obsessive–compulsive disorder: effects on cognition after 12 months
- 2023
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Ingår i: Acta Neurochirurgica. - : Springer. - 0001-6268 .- 0942-0940. ; 165:5, s. 1201-1214
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to evaluate cognitive effects 12 months after Deep Brain Stimulation (DBS) of the Bed Nucleus of Stria Terminalis (BNST) in patients with refractory Obsessive–Compulsive Disorder (OCD).Methods: Eight patients (5 female; mean ± SD age 36 ± 15) with OCD were included. A neuropsychological test battery covering verbal and spatial episodic memory, executive function, and attention was administered preoperatively and 12 months after surgery. Medical records were used as a source for descriptive data to probe for any changes not covered by standardized checklists and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the primary outcome measure.Results: At 12 months, seven patients showed response to DBS: three were full responders (i.e., Y-BOCS ≥ 35% improvement), and four were partial responders (Y-BOCS 25–34% improvement). Relative to baseline, there was a slight decline on visuo-spatial learning (p = 0.027), and improved performance on the Color-Word Interference inhibition/switching subtest (p = 0.041), suggesting improvement in cognitive flexibility.Conclusions: DBS in the BNST for treatment refractory OCD generates very few adverse cognitive effects and improves cognitive flexibility after 12 months of stimulation. The improvement in Y-BOCS and the absence of major cognitive side effects support the BNST as a potential target for DBS in severe OCD.
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| 6. |
- Sandvik, Ulrika, 1978-, et al.
(författare)
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Quality of life following DBS in the caudal zona incerta in patients with essential tremor
- 2012
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Ingår i: Acta Neurochirurgica. - Wien : Springer. - 0001-6268 .- 0942-0940. ; 154:3, s. 495-499
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Tidskriftsartikel (refereegranskat)abstract
- Background: Essential tremor (ET) is the most common movement disorder and oftenaffects the quality of life. There are only a few studies evaluating the quality of life after deepbrain stimulation (DBS). Findings: This is a prospective study of 16 patients undergoing deep brain stimulation in thecaudal Zona incerta (cZi). The quality of life was assessed with Quality of Life in EssentialTremor Questionnaire (QUEST) and SF-36 scores and the tremor was evaluated using theessential tremor rating scale (ETRS). Results: In the tremor rating hand tremor on the treated side improved by 95%, hand functionby 78% and activities of daily living improved by 74%. The QUEST score showedstatistically significant improvements in the psychosocial and activities of daily livingsubscores. The SF-36 score did not show any significant improvement. Conclusions: Although very good tremor reduction was achieved, the improvement in thequality of life scores was more modest. This could partly be explained by the quality of lifebeing affected by other factors than the tremor itself.
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