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Quality of life following DBS in the caudal zona incerta in patients with essential tremor
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Neurokirurgi.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Neurokirurgi.
2012 (Engelska)Ingår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 154, nr 3, s. 495-499Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

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.

Ort, förlag, år, upplaga, sidor
Wien: Springer, 2012. Vol. 154, nr 3, s. 495-499
Nyckelord [en]
Quality of Life, Essential tremor, Zona incerta, Deep Brain Stimulation
Nationell ämneskategori
Neurologi
Forskningsämne
neurokirurgi
Identifikatorer
URN: urn:nbn:se:umu:diva-49176DOI: 10.1007/s00701-011-1230-zOAI: oai:DiVA.org:umu-49176DiVA, id: diva2:453284
Tillgänglig från: 2011-11-02 Skapad: 2011-11-01 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Stereotactic functional procedures in the treatment of essential tremor
Öppna denna publikation i ny flik eller fönster >>Stereotactic functional procedures in the treatment of essential tremor
2011 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Essential tremor (ET) is the most common movement disorder. In cases resistant to pharmacological treatment, functional stereotactic neurosurgery can be an alternative. Lesional surgery has largely been replaced by deep brain stimulation (DBS). The current target of choice is the ventrolateral thalamus (Vim). Vim DBS has generally shown good results, but in some cases it is associated with a suboptimal effect as well as side effects. DBS in the posterior subthalamic area/caudal zona incerta (PSA/cZi) has recently shown promising effects. Recently the role of lesional therapy in selected cases has been discussed.

Aim: The aim is to evaluate stereotactic functional procedures in the treatment of ET, with special emphasis on PSA DBS. Further the effects of DBS in the PSA are evaluated. The optimal target is also assessed by evaluating the effect of Vim and PSA DBS in relation to the position of the electrode. An attempt to identify patient-specific factors of prognostic importance for the outcome after DBS will be made. The quality of life (QoL) of patients treated with PSA DBS for ET will be assessed. Finally, the aim is also to analyze retrospectively the long-term outcome of lesional procedures (thalamotomies).

Method: The thesis consists of five studies. The optimal electrode location is evaluated in a study analyzing the location of the electrode contact yielding the best effect in Vim DBS and PSA DBS groups. The efficacy of PSA DBS in 21 patients is evaluated in a prospective study. The correlation between outcome, age, tremor grade and gender is established in a prospective study consisting of 68 patients. Finally, the degree of improvement in QoL is determined in 16 patients operated on in the PSA. The very long-term effect of lesional surgery has been investigated in a retrospective study of nine patients who have undergone thalamotomy.

Results: In the study of PSA DBS the total score on the Essential Tremor Rating Scale (ETRS) was reduced by 60% compared to the baseline value. Tremor of the arm was improved by 95%. The study evaluating the optimal contact location showed that the best effect was in the PSA in 54% and in the Vim in 12%. The efficacy of DBS was not related to age, gender, or the severity of tremor with regard to the percentage reduction of tremor on stimulation. In patients with a more severe tremor at baseline, a higher degree of residual tremor on stimulation was seen. With regard to QoL, the activities of daily living (ADL) according to the ETRS score were significantly improved, as well as according to the ADL and psychosocial subscores on the Questionnaire for Essential Tremor (QUEST) scale. No significant changes were found on the generic Short Form (SF-36) QoL scale. Thalamotomy had some positive effects, but also a significant amount of side effects that might be attributed to the surgery.

Conclusions: The effect of PSA DBS was very satisfying and compares well with the results from Vim DBS. When both Vim and PSA DBS are considered, the optimal target seems to be located in the PSA. PSA DBS shows good results in improving ADL, but the results have been difficult to demonstrate on QoL scales. The efficacy of DBS could not be shown to be associated with gender or age. Nor was it associated with the severity of tremor regarding the percentage of tremor reduction on stimulation. The preoperative severity of tremor was the most important factor regarding outcome following DBS. With regard to thalamotomies, some possible remaining benefit of the surgery could be seen along with some severe side effects.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2011. s. 64
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1448
Nyckelord
Essential Tremor, Stereotactic Functional Neurosurgery, Deep Brain Stimulation, Posterior Subthalamic Area, Thalamotomy, Zona incerta, caudal Zona incerta, Quality of Life, Vim
Nationell ämneskategori
Klinisk medicin
Forskningsämne
neurokirurgi
Identifikatorer
urn:nbn:se:umu:diva-49178 (URN)978-91-7459-296-2 (ISBN)
Disputation
2011-12-02, Hörsal Betula, Byggnad 6M, Norrlands Universitetssjukhus, Umeå, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2011-11-11 Skapad: 2011-11-01 Senast uppdaterad: 2018-06-08Bibliografiskt granskad

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