Mara Seier1, Amie Hiller2,3, Joseph Quinn2,3, Charles Murchison4, Matthew Brodsky3, Shannon Anderson3. 1. Department of Neurological Sciences University of Nebraska Medical Center Omaha Nebraska USA. 2. Northwest Parkinson Disease Research Education and Clinical Center, Portland VA Medical Center Portland Oregon USA. 3. Department of Neurology Oregon Health Sciences University Portland Oregon USA. 4. Department of Biostatistics, School of Public Health University of Alabama at Birmingham Birmingham Alabama USA.
Abstract
BACKGROUND: DBS in the ventral intermediate nucleus (VIM) of the thalamus has been a revolutionary treatment for patients with essential tremor (ET) by reducing tremor. Unfortunately, some patients develop habituation to DBS and thus experience reduced efficacy and loss of tremor control. There are no standardized methods of addressing habituation to DBS. We propose alternating stimulation patterns as a way to reduce habituation. METHODS: This was a randomized, placebo-controlled trial for patients with VIM DBS for ET. Patients were randomized to either experimental treatment arm of alternating stimulation patterns on a weekly basis or standard care arm of continuous stimulation settings for 12 weeks. Primary outcome was change in the performance subscale of The Essential Tremor Rating Assessment Scale (TETRAS), which was performed at initial visit and 12-week follow-up. Secondary outcome included change in the activities of daily living subscale of TETRAS. RESULTS: Twenty-two patients were enrolled in the trial, and 16 were analyzed at follow-up. Experimental treatment subjects displayed sustained tremor control compared to standard care, as measured by the change in TETRAS performance subscale (-0.6 vs. 6.7 point change, respectively) with a 7.3 difference between the arms (P = 0.006). CONCLUSION: Alternating stimulation patterns on a weekly basis for ET patients with VIM DBS reduced habituation in this pilot study. This study suggests that exposure to different stimulation groups may maintain better tremor control compared to constant stimulation parameters.
BACKGROUND: DBS in the ventral intermediate nucleus (VIM) of the thalamus has been a revolutionary treatment for patients with essential tremor (ET) by reducing tremor. Unfortunately, some patients develop habituation to DBS and thus experience reduced efficacy and loss of tremor control. There are no standardized methods of addressing habituation to DBS. We propose alternating stimulation patterns as a way to reduce habituation. METHODS: This was a randomized, placebo-controlled trial for patients with VIM DBS for ET. Patients were randomized to either experimental treatment arm of alternating stimulation patterns on a weekly basis or standard care arm of continuous stimulation settings for 12 weeks. Primary outcome was change in the performance subscale of The Essential Tremor Rating Assessment Scale (TETRAS), which was performed at initial visit and 12-week follow-up. Secondary outcome included change in the activities of daily living subscale of TETRAS. RESULTS: Twenty-two patients were enrolled in the trial, and 16 were analyzed at follow-up. Experimental treatment subjects displayed sustained tremor control compared to standard care, as measured by the change in TETRAS performance subscale (-0.6 vs. 6.7 point change, respectively) with a 7.3 difference between the arms (P = 0.006). CONCLUSION: Alternating stimulation patterns on a weekly basis for ET patients with VIM DBS reduced habituation in this pilot study. This study suggests that exposure to different stimulation groups may maintain better tremor control compared to constant stimulation parameters.
Entities:
Keywords:
VIM; deep brain stimulation; essential tremor; habituation
Authors: Michael T Barbe; Lena Liebhart; Matthias Runge; K Amande M Pauls; Lars Wojtecki; Alfons Schnitzler; Niels Allert; Gereon R Fink; Volker Sturm; Mohammad Maarouf; Lars Timmermann Journal: J Neurol Date: 2010-10-08 Impact factor: 4.849
Authors: Martin Kronenbuerger; Christoph Fromm; Frank Block; Volker A Coenen; Ina Rohde; Veit Rohde; Johannes Noth Journal: Mov Disord Date: 2006-03 Impact factor: 10.338
Authors: Julie G Pilitsis; Leo Verhagen Metman; John R Toleikis; Lindsay E Hughes; Sepehr B Sani; Roy A E Bakay Journal: J Neurosurg Date: 2008-10 Impact factor: 5.115
Authors: Jan Niklas Petry-Schmelzer; Paul Reker; Jil Pochmann; Veerle Visser-Vandewalle; Till A Dembek; Michael T Barbe Journal: Mov Disord Clin Pract Date: 2019-05-11
Authors: Joshua K Wong; Christopher W Hess; Leonardo Almeida; Erik H Middlebrooks; Evangelos A Christou; Erin E Patrick; Aparna Wagle Shukla; Kelly D Foote; Michael S Okun Journal: Expert Rev Neurother Date: 2020-03-02 Impact factor: 4.618
Authors: Joshua K Wong; Günther Deuschl; Robin Wolke; Hagai Bergman; Muthuraman Muthuraman; Sergiu Groppa; Sameer A Sheth; Helen M Bronte-Stewart; Kevin B Wilkins; Matthew N Petrucci; Emilia Lambert; Yasmine Kehnemouyi; Philip A Starr; Simon Little; Juan Anso; Ro'ee Gilron; Lawrence Poree; Giridhar P Kalamangalam; Gregory A Worrell; Kai J Miller; Nicholas D Schiff; Christopher R Butson; Jaimie M Henderson; Jack W Judy; Adolfo Ramirez-Zamora; Kelly D Foote; Peter A Silburn; Luming Li; Genko Oyama; Hikaru Kamo; Satoko Sekimoto; Nobutaka Hattori; James J Giordano; Diane DiEuliis; John R Shook; Darin D Doughtery; Alik S Widge; Helen S Mayberg; Jungho Cha; Kisueng Choi; Stephen Heisig; Mosadolu Obatusin; Enrico Opri; Scott B Kaufman; Prasad Shirvalkar; Christopher J Rozell; Sankaraleengam Alagapan; Robert S Raike; Hemant Bokil; David Green; Michael S Okun Journal: Front Hum Neurosci Date: 2022-03-04 Impact factor: 3.473
Authors: I Daria Bogdan; Teus van Laar; D L Marinus Oterdoom; Gea Drost; J Marc C van Dijk; Martijn Beudel Journal: J Clin Med Date: 2020-06-14 Impact factor: 4.241