Top

Published in:

01-02-2017 | Case Report - Functional

Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson’s disease

Authors: Markus F. Oertel, W. Michael M. Schüpbach, Joseph-André Ghika, Lennart H. Stieglitz, Michael Fiechter, Alain Kaelin-Lang, Andreas Raabe, Claudio Pollo

Published in: Acta Neurochirurgica | Issue 2/2017

Abstract

Deep brain stimulation (DBS) in the thalamic ventral intermediate (Vim) or the subthalamic nucleus (STN) reportedly improves medication-refractory Parkinson’s disease (PD) tremor. However, little is known about the potential synergic effects of combined Vim and STN DBS. We describe a 79-year-old man with medication-refractory tremor-dominant PD. Bilateral Vim DBS electrode implantation produced insufficient improvement. Therefore, the patient underwent additional unilateral left-sided STN DBS. Whereas Vim or STN stimulation alone led to partial improvement, persisting tremor resolution occurred after simultaneous stimulation. The combination of both targets may have a synergic effect and is an alternative option in suitable cases.

Anheim M, Batir A, Fraix V, Silem M, Chabardès S, Seigneuret E, Krack P, Benabid AL, Pollak P (2008) Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. Arch Neurol 65:612–616PubMed

Blomstedt P, Fytagoridis A, Åström M, Linder J, Forsgren L, Hariz MI (2012) Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor. Parkinsonism Relat Disord 18:1062–1066CrossRefPubMed

Blomstedt P, Lindvall P, Linder J, Olivecrona M, Forsgren L, Hariz MI (2012) Reoperation after failed deep brain stimulation for essential tremor. World Neurosurg 78:7554.e1–7554.e5CrossRef

Coenen VA, Allert N, Paus S, Kronenbürger M, Urbach H, Mädler B (2014) Modulation of the cerebello-thalamo-cortical network in thalamic deep brain stimulation for tremor: a diffusion tensor imaging study. Neurosurgery 75:657–670CrossRefPubMed

Ellis TM, Foote KD, Fernandez HH, Sudhyadhom A, Rodriguez RL, Zeilman P, Jacobson CE 4th, Okun MS (2008) Reoperation for suboptimal outcomes after deep brain stimulation surgery. Neurosurgery 63:754–761CrossRefPubMed

Fraix V, Pollak P, Moro E, Chabardes S, Xie J, Ardouin C, Benabid AL (2005) Subthalamic nucleus stimulation in tremor dominant parkinsonian patients with previous thalamic surgery. J Neurol Neurosurg Psychiatry 76:246–248CrossRefPubMedPubMedCentral

Gallay MN, Jeanmonod D, Liu J, Morel A (2008) Human pallidothalamic and cerebellothalamic tracts: anatomical basis for functional stereotactic neurosurgery. Brain Struct Funct 212:443–463CrossRefPubMedPubMedCentral

Granziera C, Pollo C, Russmann H, Staedler C, Ghika J, Villemure JG, Burkhard PR, Vingerhoets FJ (2008) Sub-acute delayed failure of subthalamic DBS in Parkinson’s disease: the role of micro-lesion effect. Parkinsonism Relat Disord 14:109–113CrossRefPubMed

Hamel W, Herzog J, Kopper F, Pinsker M, Weinert D, Müller D, Krack P, Deuschl G, Mehdorn HM (2007) Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor. Acta Neurochir (Wien) 149:749–758CrossRef

10.

Hariz MI, Krack P, Alesch F, Augustinsson LE, Bosch A, Ekberg R, Johansson F, Johnels B, Meyerson BA, N’Guyen JP, Pinter M, Pollak P, von Raison F, Rehncrona S, Speelman JD, Sydow O, Benabid AL (2008) Multicentre European study of thalamic stimulation for parkinsonian tremor: a 6 years follow-up. J Neurol Neurosurg Psychiatry 79:694–699CrossRefPubMed

11.

Khan S, Gill SS, Mooney L, White P, Whone A, Brooks DJ, Pavese N (2012) Combined pedunculopontine-subthalamic stimulation in Parkinson disease. Neurology 78:1090–1095CrossRefPubMedPubMedCentral

12.

Khan S, Javed S, Mooney L, White P, Plaha P, Whone A, Gill SS (2012) Clinical outcomes from bilateral versus unilateral stimulation of the pedunculopontine nucleus with and without concomitant caudal zona incerta region stimulation in Parkinson’s disease. Br J Neurosurg 26:722–725CrossRefPubMed

13.

Khan S, Mooney L, Plaha P, Javed S, White P, Whone AL, Gill SS (2011) Outcomes from stimulation of the caudal zona incerta and pedunculopontine nucleus in patients with Parkinson’s disease. Br J Neurosurg 25:273–280CrossRefPubMed

14.

Kim HJ, Jeon BS, Paek SH, Lee JY, Kim HJ, Kim CK, Kim DG (2010) Bilateral subthalamic deep brain stimulation in Parkinson disease patients with severe tremor. Neurosurgery 67:626–632CrossRefPubMed

15.

Mazzone P, Brown P, Dilazzaro V, Stanzione P, Oliviero A, Peppe A, Santilli V, Insola A, Altibrandi M (2005) Bilateral implantation in globus pallidus internus and in subthalamic nucleus in Parkinson’s disease. Neuromodulation 8:1–6CrossRefPubMed

16.

Mazzone P, Stocchi F, Galati S, Insola A, Altibrandi MG, Modugno N, Tropepi D, Brusa L, Stefani A (2006) Bilateral implantation of centromedian-parafascicularis complex and GPi: a new combination of unconventional targets for deep brain stimulation in severe Parkinson disease. Neuromodulation 9:221–228CrossRefPubMed

17.

Peppe A, Gasbarra A, Stefani A, Chiavalon C, Pierantozzi M, Fermi E, Stanzione P, Caltagirone C, Mazzone P (2008) Deep brain stimulation of CM/PF of thalamus could be the new elective target for tremor in advanced Parkinson’s disease? Parkinsonism Relat Disord 14:501–504CrossRefPubMed

18.

Peppe A, Pierantozzi M, Bassi A, Altibrandi MG, Brusa L, Stefani A, Stanzione P, Mazzone P (2004) Stimulation of the subthalamic nucleus compared with the globus pallidus internus in patients with Parkinson disease. J Neurosurg 101:195–200CrossRefPubMed

19.

Peppe A, Pierantozzi M, Chiavalon C, Marchetti F, Caltagirone C, Musicco M, Stanzione P, Stefani A (2010) Deep brain stimulation of the pedunculopontine tegmentum and subthalamic nucleus: effects on gait in Parkinson’s disease. Gait Posture 32:512–518CrossRefPubMed

20.

Romanelli P, Brontë-Stewart H, Courtney T, Heit G (2003) Possible necessity for deep brain stimulation of both the ventralis intermedius and subthalamic nuclei to resolve Holmes tremor. Case report. J Neurosurg 99:566–571CrossRefPubMed

21.

Stefani A, Lozano AM, Peppe A, Stanzione P, Galati S, Tropepi D, Pierantozzi M, Brusa L, Scarnati E, Mazzone P (2007) Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson’s disease. Brain 130:1596–1607CrossRefPubMed

22.

Stefani A, Peppe A, Pierantozzi M, Galati S, Moschella V, Stanzione P, Mazzone P (2009) Multi-target strategy for parkinsonian patients: the role of deep brain stimulation in the centromedian-parafascicularis complex. Brain Res Bull 78:113–118CrossRefPubMed

Title: Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson’s disease
Authors: Markus F. Oertel
W. Michael M. Schüpbach
Joseph-André Ghika
Lennart H. Stieglitz
Michael Fiechter
Alain Kaelin-Lang
Andreas Raabe
Claudio Pollo
Publication date: 01-02-2017
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 2/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-016-3044-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson’s disease

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2017

The role of magnetic resonance imaging in the evaluation of peripheral nerves following traumatic lesion: where do we stand?

Growing skull hemangioma: first and unique description in a patient with Klippel–Trénaunay–Weber syndrome

Progressive hemorrhagic injury in patients with traumatic intracerebral hemorrhage: characteristics, risk factors and impact on management

Fluorescein sodium-guided resection of cerebral metastases—an update

Failed microvascular decompression surgery for hemifacial spasm: a retrospective clinical study of reoperations

Frontal skull osteoblastoma with aneurysmal bone cyst-like changes associated with trauma during pregnancy: a case report