Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The neuroanatomic substrate for restless legs syndrome (RLS) is not known. We implanted deep brain stimulators into the ventralis intermedius nucleus (VIM) of the thalamus in nine subjects for essential tremor (ET) whom all concurrently had RLS. Although the VIM DBS improved tremor, none of the subjects felt there was any meaningful effect on their RLS symptoms. The VIM thalamus, which is involved in ET and Parkinson's disease, does not seem to be primarily involved in RLS.
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PMID:VIM deep brain stimulation does not improve pre-existing restless legs syndrome in patients with essential tremor. 1644 10

To determine whether the degree to which a patient with Parkinson's disease expects therapeutic benefit from subthalamic nucleus-deep brain stimulation (STN-DBS) influences the magnitude of his or her improved motor response, 10 patients with idiopathic Parkinson's and bilateral STN-DBS were tested after a 12-hour period off medication and stimulation. Four consecutive UPDRS III scores were performed in the following conditions: (a) stimulation OFF, patient aware; (b) stimulation OFF, patient blind; (c) stimulation ON, patient aware; and (d) stimulation ON, patient blind. Statistical significance (P = 0.0001) was observed when comparing main effect ON versus OFF (mean ON: 32.55; mean OFF: 49.15). When the stimulation was OFF, patients aware of this condition had higher UPDRS motor scores than when they were blinded (mean: 50.7 vs. 47.6). With the stimulation ON, UPDRS motor scores were lower when the patients were aware of the stimulation compared with when they were blinded (mean: 30.6 vs. 34.5). The interaction between these levels was significant (P = 0.049). This variation was important for bradykinesia and was not significant for tremor and rigidity. The authors conclude that the information about the condition of the stimulation enhanced the final clinical effect in opposite directions. The results presented support the role of expectation and placebo effects in STN-DBS in Parkinson's disease patients.
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PMID:Expectation and the placebo effect in Parkinson's disease patients with subthalamic nucleus deep brain stimulation. 1672 50

Generalized dystonia is a disabling disorder that can severely affect quality of life. Pharmacological treatment is unsatisfactory, and surgical therapy has been the focus for symptom improvement. We present the first case report of a patient with disabling generalized dystonia treated with a thalamotomy and deep brain stimulation of the thalamus and globus pallidus (DBS-Vim, DBS-GPi). His tremor and dystonic symptoms have dramatically improved through combining these surgical interventions.
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PMID:Thalamotomy, DBS-Vim, and DBS-GPi for generalized dystonia: a case report. 1737 6

DBS is increasingly used for Parkinson's disease, essential tremor and other movement disorders. The advertised battery life for Medtronic implantable pulse generators is 4-5 years, but can vary markedly. Theoretical formulas exist to predict battery life as a function of parameter setting, but almost no empiric confirmation of these predictions has been reported. We identified all battery replacements done for actual expired batteries and low voltage batteries. Demographic data were collected and the adjustable settings over the entire life of that battery were formulated longitudinally. The individual contributions of co-variables on the longevity of IPG devices were assessed by survival analysis based on the Kaplan-Meier estimator and log rank test. We have replaced a total of 122 batteries in 73 patients, 50 males (42 PD, 29 ET, two dystonias, one multiple sclerosis). The median life of these replaced batteries was 37.4+/-17.3 months [range: 4-93 months]. The batteries that completely expired were actually replaced sooner at 31.7+/-14.3 months [range: 4-74 months]. In this group, the main predictors of a shorter battery life were greater amplitude (p=0.002), pulse width (p=0.026), and not using exclusive bipolar settings (p=0.029). The implant location, underlying disease, and sex did not affect battery life. Battery life varied but was generally consistent with published predictors.
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PMID:Predictors of battery life for the Activa Soletra 7426 Neurostimulator. 1737 65

Tremor in multiple sclerosis is considered to be a persistent and progressive sign. We describe five patients with multiple sclerosis in whom upper limb tremor severity gradually decreased over a period of several years after deep brain stimulation. In every case this attenuation of tremor was accompanied by increasing pyramidal weakness in the relevant upper limb. In two patients this attenuation of tremor remained after stimulation was permanently switched off. In one other patient, where upper limb strength remained normal, tremor severity gradually worsened in spite of continuing stimulation. There was a highly significant difference (p = 0.0007) between the changes in intention tremor severities when the arms with increasing pyramidal weakness (n = 9) were compared to those in which normal strength was retained throughout follow-up period (n = 3); intention tremor decreased in the former and increased in the latter by means of -3.66 and +4.0 points of a 0-10 tremor scale respectively. There was also a significant correlation (0.699; p = 0.0359) between decreasing upper limb strength and decreasing intention tremor severity for the upper limbs of patients that had undergone contralateral DBS.
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PMID:Post-deep brain stimulation--gradual non-stimulation dependent decrease in strength with attenuation of multiple sclerosis tremor. 1743 3

Deep brain stimulation of the thalamus (thalamic DBS) is an established therapy for medically intractable essential tremor and tremor caused by multiple sclerosis. In both disorders, motor disability results from complex interaction between kinetic tremor and accompanying ataxia with voluntary movements. In clinical studies, the efficacy of thalamic DBS has been thoroughly assessed. However, the optimal anatomical target structure for neurostimulation is still debated and has never been analysed in conjunction with objective measurements of the different aspects of motor impairment. In 10 essential tremor and 11 multiple sclerosis patients, we analysed the effect of thalamic DBS through each contact of the quadripolar electrode on the contralateral tremor rating scale, accelerometry and kinematic measures of reach-to-grasp-movements. These measures were correlated with the anatomical position of the stimulating electrode in stereotactic space and in relation to nuclear boundaries derived from intraoperative microrecording. We found a significant impact of the stereotactic z-coordinate of stimulation contacts on the TRS, accelerometry total power and spatial deviation in the deceleration and target period of reach-to-grasp-movements. Most effective contacts clustered within the subthalamic area (STA) covering the posterior Zona incerta and prelemniscal radiation. Stimulation within this region led to a mean reduction of the lateralized tremor rating scale by 15.8 points which was significantly superior to stimulation within the thalamus (P < 0.05, student's t-test). STA stimulation resulted in reduction of the accelerometry total power by 99%, whereas stimulation at the ventral thalamic border (68%) or within the thalamus proper (2.5%) was significantly less effective (P < 0.01). Concomitantly, STA stimulation led to a significantly higher increase of tremor frequency and decrease in EMG synchronization compared to stimulation within the thalamus proper (P < 0.001). In reach-to-grasp movements, STA stimulation reduced the spatial variability of the movement path in the deceleration period by 28.9% and in the target period by 58.4%, whereas stimulation within the thalamus was again significantly less effective (P < 0.05), with a reduction in the deceleration period between 6.5 and 21.8% and in the target period between 1.2 and 11.3%. An analysis of the nuclear boundaries from intraoperative microrecording confirmed the anatomical impression that most effective electrodes were located within the STA. Our data demonstrate a profound effect of deep brain stimulation of the thalamic region on tremor and ataxia in essential tremor and tremor caused by multiple sclerosis. The better efficacy of stimulation within the STA compared to thalamus proper favours the concept of a modulation of cerebello-thalamic projections underlying the improvement of these symptoms.
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PMID:Kinematic analysis of thalamic versus subthalamic neurostimulation in postural and intention tremor. 1743 79

Disabling tremor is common in multiple sclerosis and up to 75% of patients experience tremor at some point during their disease. The treatment of this tremor, however, remains challenging. Pharmacotherapy in general has been disappointing and stereotactic neurosurgery is becoming increasingly popular. However, the results of stereotactic treatments reported are variable and no systematic review has been performed. The aim of this study was to assess the role of thalamotomy and deep brain stimulation in the treatment of tremor in multiple sclerosis, and to compare the differences in efficacy and safety between the two techniques. We identified the relevant published studies and cases by searching the MEDLINE, EMBASS and the references lists of related articles, and performed a systematic review and assessment of the full texts of all articles selected. Initial tremor suppression was seen in 93.8% of patients who had thalamotomy and 96% in those who had deep brain stimulation. A total of 63.5% of patients had persistent tremor suppression at 12 months or more after thalamotomy. Twelve results for deep brain stimulation were not available in the reviewed literature. Functional improvement was seen only in 47.8% of those who underwent thalamotomy as opposed to 85.2% of those who had deep brain stimulation. While three of the four reported deaths were in patients who underwent thalamotomy, three of the four procedure-related haemorrhages followed DBS. Other common adverse effects like hemiparesis, dysarthria, swallowing difficulties, balance disorder, etc., was reported in both procedures. Numerous studies have attempted to assess the efficacy and safety of thalamotomy and DBS in the treatment of MS tremor, but no standardized outcome measures were used. Nonetheless, the data suggest that both thalamotomy and thalamic DBS are comparable procedures for tremor suppression and that adverse effects can occur with both procedures.
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PMID:Stereotactic neurosurgery for disabling tremor in multiple sclerosis: thalamotomy or deep brain stimulation? 1767 53

Deep brain stimulation of ventral intermediate nucleus (VIM-DBS) has become an established therapy for severe essential tremor (ET). The technique is however limited in some ET patients by relevant side effects such as paresthesia, dysarthria, and gait disturbances. To our knowledge, this is the first report of VIM-DBS-induced reversible hypogeusia along with retroinsular cortical deactivation under effective VIM stimulation measured with 18-fluorodexoglucose positron emission tomography. This case demonstrates that gustatory dysfunction should be considered in the pre- and postsurgical management of patients with VIM-DBS. Moreover it provides direct evidence that the thalamus acts as an important relay station in the human cerebral gustatory pathway.
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PMID:[Reversible hypogeusia during bilateral thalamic stimulation for essential tremor]. 1822 99

Currently, no study of subthalamic nucleus (STN) stimulation has compared continuous stimulation with a period of short-term stimulation, which is frequently employed in the clinic and in research studies. Therefore, this study examined the effects of STN stimulation over 90 min (short) and greater than 3 months (long) on the cardinal signs of Parkinson's disease. The 90 min time period immediately followed a 12 hour withdrawal from both STN stimulation and medication. Ten PD patients who received STN stimulation were studied. Bradykinesia, rigidity, and tremor were evaluated using the UPDRS and motor control measures which included peak velocity (bradykinesia), work (rigidity), and amplitude (tremor). Results showed no difference between 90 min and greater than 3 months of STN stimulation for the UPDRS or motor control measures. This finding confirms that the treatment efficacy that is derived from a relatively short time course of stimulation generalizes to longer time periods of high frequency STN stimulation that patients experience in their daily lives. As such, it is reasonable to evaluate the effect of DBS after 90 min of stimulation in clinical trials and research studies.
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PMID:Effect of short and long term STN stimulation periods on parkinsonian signs. 1831 27

The intra-laminar (IL) thalamic complex, composed of centromedian (CM) and parafascicular (Pf) nucleus, is a strategic crossroad for the activity of the basal ganglia and is recently regaining its position has a putative neurosurgical target for Parkinsonian syndromes. The multi-target approach we have encouraged since the late nineties has allowed the combined implantation of a standard target (the subthalamic nucleus-STN or the internal pallidus-GPi) plus an innovative one (CM/Pf) in well-identified Parkinson's disease (PD) patients; hence, it is possible to study, in the same PD patients, the specific target-mediated effects on different clinical signs. Here, we focus on the potential usefulness of implanting the CM/Pf complex when required in the management of contra-lateral tremor (resistant to standard deep brain stimulation-DBS - in STN - , n=2) and disabling involuntary movements, partially responsive to GPi-DBS (n=6). When considering global UPDRS scores, CM/Pf-DBS ameliorate extra-pyramidal symptoms but not as strongly as STN (or GPi) does. Yet, CM/Pf acts very powerfully on tremor and contributes to the long-term management of l-Dopa-induced involuntary movements. The lack of cognitive deficits and psychic impairment associated with the improvement of their quality of life, in our small cohort of CM/Pf implanted patients, reinforces the notion of CM/Pf as a safe and attractive area for surgical treatment of advanced PD, possibly affecting not only motor but also associative functions.
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PMID:Multi-target strategy for Parkinsonian patients: the role of deep brain stimulation in the centromedian-parafascicularis complex. 1881 14


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