Umeå University's logo

umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
10 years follow-up of deep brain stimulation in the caudal zona incerta/posterior subthalamic area for essential tremor
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
Show others and affiliations
2023 (English)In: Movement Disorders Clinical Practice, E-ISSN 2330-1619, Vol. 10, no 5, p. 783-793Article in journal (Refereed) Published
Abstract [en]

Background: Long-term data on the effects of deep brain stimulation (DBS) for essential tremor (ET) is scarce, especially regarding DBS in the caudal Zona incerta (cZi) and the posterior subthalamic area (PSA). Objectives: The aim of this prospective study was to evaluate the effect of cZi/PSA DBS in ET at 10 years after surgery.

Methods: Thirty-four patients were included. All patients received cZi/PSA DBS (5 bilateral/29 unilateral) and were evaluated at regular intervals using the essential tremor rating scale (ETRS).

Results: One year after surgery, there was a 66.4% improvement of total ETRS and 70.7% improvement of tremor (items 1–9) compared with the preoperative baseline. Ten years after surgery, 14 patients had died and 3 were lost to follow-up. In the remaining 17 patients, a significant improvement was maintained (50.8% for total ETRS and 55.8% for tremor items). On the treated side the scores of hand function (items 11–14) had improved by 82.6% at 1 year after surgery, and by 66.1% after 10 years. Since off-stimulation scores did not differ between year 1 and 10, this 20% deterioration of on-DBS scores was interpreted as a habituation. There was no significant increase in stimulation parameters beyond the first year.

Conclusions: This 10 year follow up study, found cZi/PSA DBS for ET to be a safe procedure with a mostly retained effect on tremor, compared to 1 year after surgery, and in the absence of increase in stimulation parameters. The modest deterioration of effect of DBS on tremor was interpreted as habituation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023. Vol. 10, no 5, p. 783-793
Keywords [en]
DBS, essential tremor, long-term follow-up, posterior subthalamic area, zona incerta
National Category
Neurology Surgery
Identifiers
URN: urn:nbn:se:umu:diva-206764DOI: 10.1002/mdc3.13729ISI: 000961376000001Scopus ID: 2-s2.0-85151937204OAI: oai:DiVA.org:umu-206764DiVA, id: diva2:1753657
Funder
Swedish Research Council, 2018-00618Available from: 2023-04-28 Created: 2023-04-28 Last updated: 2023-11-13Bibliographically approved
In thesis
1. Deep brain stimulation targeting the caudal zona incerta as a treatment for parkinsonian and essential tremor
Open this publication in new window or tab >>Deep brain stimulation targeting the caudal zona incerta as a treatment for parkinsonian and essential tremor
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Deep brain stimulation (DBS) is used as a treatment for Parkinson’s disease (PD) and Essential tremor (ET) when medications are insufficient. The most common DBS-targets for PD and ET, the subthalamic nucleus (STN) and the ventral intermediate nucleus of the thalamus (Vim) respectively, have certain side effects and limitations. In the early 2000s, the posterior subthalamic area (PSA) was introduced as an alternative DBS-target with good results on PD and ET in non-blinded, non-randomised, short-term studies. Different structures in the PSA, such as the caudal zona incerta (cZi), have been used as targets but an optimal target within this area has not been established. Furthermore, there has been an increased interest in asleep DBS surgery but with a paucity of results of asleep surgery for ET, as the Vim is not visible on conventional MRI.

Aims: To evaluate DBS targeting the cZi for PD in a blinded, randomised manner. To spatially map the effects of DBS within the PSA. To evaluate the long-term effects of cZi-DBS on PD tremor and ET. To analyse the outcome of awake and asleep cZi-DBS surgery for ET. 

Method: The thesis is based on five studies. Bilateral cZi-DBS was compared to Best Medical Treatment for PD in a randomised blinded trial. The long-term effects of unilateral cZi-DBS on PD tremor were evaluated retrospectively. Prospectively collected data on cZi-DBS for ET were used to evaluate long-term effects and compare awake and asleep surgery. The effects of cZi-DBS were spatially mapped within the PSA using electric field simulations and contact location in relation to the STN.

Results: Bilateral cZi-DBS improved motor symptoms and quality of life in patients with PD in both blinded and non-blinded evaluations with a pronounced effect on tremor (90%) and a modest on bradykinesia (25-40%). The effects of unilateral cZi-DBS on PD tremor remained undiminished at a mean of five years after surgery. cZi-DBS significantly improved ET 10 years after surgery with a slight deterioration over time. Asleep surgery had similar effects and side effects as awake surgery for patients with ET. Electric field simulations did not reveal an optimal target but together with contact location analyses consistently found that the stimulation was concentrated within the PSA, overlapping the cZi and the cerebellothalamic tract. 

Conclusion: DBS targeting the cZi reliably achieved a pronounced effect on PD tremor and ET up to at least five and ten years after surgery respectively. In addition, cZi-DBS had a modest effect on bradykinesia and improved quality of life in patients with PD. Finally, targeting the cZi enabled asleep surgery with seemingly similar efficacy as awake surgery for ET.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2023. p. 140
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2267
Keywords
movement disorders, parkinson's disease, tremor, essential tremor, deep brain stimulation, zona incerta, posterior subthalamic area
National Category
Neurology Neurosciences
Research subject
Neurology; Neurosurgery
Identifiers
urn:nbn:se:umu:diva-216408 (URN)978-91-8070-208-9 (ISBN)978-91-8070-209-6 (ISBN)
Public defence
2023-12-08, Hörsal B, målpunkt T, by 1D, plan 9,, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Funder
Swedish Research Council
Available from: 2023-11-17 Created: 2023-11-13 Last updated: 2023-11-15Bibliographically approved

Open Access in DiVA

fulltext(1153 kB)86 downloads
File information
File name FULLTEXT02.pdfFile size 1153 kBChecksum SHA-512
1a405ff33ce7ab81fc508457162ee1d59c94d842f820707835db71f4c9d37ca145eb357901fd48792afb516e7e25f60cafaae2f5970ebd83738e2897ea612c89
Type fulltextMimetype application/pdf

Other links

Publisher's full textScopus

Authority records

Blomstedt, YuliaStenmark Persson, RasmusAwad, AmarHariz, Gun-MariePhilipson, JohannaHariz, MarwanBlomstedt, Patric

Search in DiVA

By author/editor
Blomstedt, YuliaStenmark Persson, RasmusAwad, AmarHariz, Gun-MariePhilipson, JohannaHariz, MarwanBlomstedt, Patric
By organisation
Department of Public Health and Clinical MedicineNeurosciencesPhysiology
In the same journal
Movement Disorders Clinical Practice
NeurologySurgery

Search outside of DiVA

GoogleGoogle Scholar
Total: 102 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 443 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf