Umeå universitets logga

umu.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
10 years follow-up of deep brain stimulation in the caudal zona incerta/posterior subthalamic area for essential tremor
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper. Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
Visa övriga samt affilieringar
2023 (Engelska)Ingår i: Movement Disorders Clinical Practice, E-ISSN 2330-1619, Vol. 10, nr 5, s. 783-793Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2023. Vol. 10, nr 5, s. 783-793
Nyckelord [en]
DBS, essential tremor, long-term follow-up, posterior subthalamic area, zona incerta
Nationell ämneskategori
Neurologi Kirurgi
Identifikatorer
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
Forskningsfinansiär
Vetenskapsrådet, 2018-00618Tillgänglig från: 2023-04-28 Skapad: 2023-04-28 Senast uppdaterad: 2023-11-13Bibliografiskt granskad
Ingår i avhandling
1. Deep brain stimulation targeting the caudal zona incerta as a treatment for parkinsonian and essential tremor
Öppna denna publikation i ny flik eller fönster >>Deep brain stimulation targeting the caudal zona incerta as a treatment for parkinsonian and essential tremor
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2023. s. 140
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2267
Nyckelord
movement disorders, parkinson's disease, tremor, essential tremor, deep brain stimulation, zona incerta, posterior subthalamic area
Nationell ämneskategori
Neurologi Neurovetenskaper
Forskningsämne
neurologi; neurokirurgi
Identifikatorer
urn:nbn:se:umu:diva-216408 (URN)978-91-8070-208-9 (ISBN)978-91-8070-209-6 (ISBN)
Disputation
2023-12-08, Hörsal B, målpunkt T, by 1D, plan 9,, Norrlands universitetssjukhus, Umeå, 09:00 (Engelska)
Opponent
Handledare
Forskningsfinansiär
Vetenskapsrådet
Tillgänglig från: 2023-11-17 Skapad: 2023-11-13 Senast uppdaterad: 2023-11-15Bibliografiskt granskad

Open Access i DiVA

fulltext(1153 kB)92 nedladdningar
Filinformation
Filnamn FULLTEXT02.pdfFilstorlek 1153 kBChecksumma SHA-512
1a405ff33ce7ab81fc508457162ee1d59c94d842f820707835db71f4c9d37ca145eb357901fd48792afb516e7e25f60cafaae2f5970ebd83738e2897ea612c89
Typ fulltextMimetyp application/pdf

Övriga länkar

Förlagets fulltextScopus

Person

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

Sök vidare i DiVA

Av författaren/redaktören
Blomstedt, YuliaStenmark Persson, RasmusAwad, AmarHariz, Gun-MariePhilipson, JohannaHariz, MarwanBlomstedt, Patric
Av organisationen
Institutionen för folkhälsa och klinisk medicinNeurovetenskaperFysiologi
I samma tidskrift
Movement Disorders Clinical Practice
NeurologiKirurgi

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 108 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

doi
urn-nbn

Altmetricpoäng

doi
urn-nbn
Totalt: 453 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf