Thalamic and subthalamic DBS for essential tremor : where is the optimal target?

• Background: The ventrolateral thalamus (Vim, ventral intermediate nucleus) is the traditional target for neurosurgical treatment of essential tremor (ET). The target has, however, varied substantially among different neurosurgeons.Objective: To evaluate the effect of deep brain stimulation (DBS) in the thalamus and posterior subthalamic area (PSA) in relation to electrode location.Methods: 36 (17Vim / 19 PSA) patients, with 44 DBS electrodes, were included in this retrospective study. The effect of stimulation was evaluated with standardized settings for each contact using items from the essential tremor rating scale (ETRS).Results: When each contact was evaluated regarding the treated hand with standardized stimulation, the electrode contact providing the best effect in the individual patient was in 54% located in the zona incerta (Zi) or radiation prelemniscalis (raprl) and in 12 % the Vim. 40 contacts provided a tremor reduction of >90%. Of these, 43% were located in the PSA and 18% in the Vim according to the Schaltenbrandt atlas. 37 of these 40 contacts were found in the PSA group.Conclusion: More contacts yielding an optimal effect were found in the PSA group than in the Vim. Many patients operated upon in the Vim got the best effect in a contact located in the PSA. This might suggest that the PSA is a more efficient target than the Vim.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Neurovetenskaper (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Neurosciences (hsv//eng)

Nyckelord

Essential tremor

Deep Brain Stimulation

Posterior Subthalamic Area

Zona incerta

Vim

neurokirurgi

Neurosurgery

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