Long-Term Outcome and Neuroimaging of Deep Brain Stimulation in Holmes Tremor: A Case Series.

Bargiotas, Panagiotis; Nguyen, T. A. Khoa; Bracht, Tobias; Mürset, Melina; Nowacki, Andreas; Debove, Ines; Müllner, Julia; Michelis, Joan P.; Pollo, Claudio; Schüpbach, W. M. Michael; Lachenmayer, Lenard (2021). Long-Term Outcome and Neuroimaging of Deep Brain Stimulation in Holmes Tremor: A Case Series. Neuromodulation, 24(2), pp. 392-399. Wiley 10.1111/ner.13352

[img] Text
Bargiotas__2021__Long_term_Outcome_and_Neuroimaging.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

BACKGROUND

Different deep brain stimulation (DBS) targets have been suggested as treatment for patients with pharmacologically refractory Holmes tremor (HT). We report the clinical and quality of life (QoL) long-term (up to nine years) outcome in four patients with HT treated with DBS (in thalamic ventral intermediate nucleus-VIM or in dentato-rubro-thalamic tract-DRTT).

MATERIALS AND METHODS

The patients underwent routine clinical evaluations before and after DBS (typically annually). Tremor severity and activities of daily living (ADL) were quantified by the Fahn-Tolosa-Marin Tremor-Rating-Scale (FTMTRS). QoL was assessed using the RAND SF-36-item Health Survey (RAND SF-36). In addition, we computed, in all four patients, the VTA based on the best stimulation settings using heuristic approaches included in the open source toolbox LEAD-DBS.

RESULTS

In all patients, tremor and ADL improved significantly at one-year post-DBS follow-up (34-61% improvement in FTMTRS total score compared to baseline). In three out of four patients, the improvement of tremor was sustained no longer than two to three years and only in one patient was sustained up to nine years. In this patient, the largest intersection between VTA and DBS target has been observed. Scores for ADL deteriorated over the course of time, reaching worse levels compared to baseline already during the three-year post-DBS follow-up, in three out of four patients. Physical and mental health component scores of RAND SF-36 had very different outcome between patients and follow-ups and were not associated with tremor-related outcomes.

CONCLUSIONS

The benefits of DBS in HT might not be always long lasting. Although QoL slightly improved, this change seemed to be independent of the motor outcome following DBS. The estimation of DBS target and VTA proximity could be a useful tool for DBS clinicians in order to facilitate the DBS programming process and optimize DBS treatment.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy > Translational Research Center
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research

UniBE Contributor:

Bargiotas, Panagiotis; Nguyen, T A Khoa; Bracht, Tobias; Nowacki, Andreas; Debove, Ines; Müllner, Julia Nicole Maria; Michelis, Joan Philipp; Pollo, Claudio; Schüpbach, Michael and Lachenmayer, Lenard

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

1525-1403

Publisher:

Wiley

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

20 Jan 2021 14:33

Last Modified:

21 Feb 2021 01:36

Publisher DOI:

10.1111/ner.13352

PubMed ID:

33389771

Uncontrolled Keywords:

Deep brain stimulation Holmes tremor Rubral tremor dentato-rubro-thalamic tract quality of life tractography ventral intermediate nucleus volume of tissue activated

BORIS DOI:

10.48350/150765

URI:

https://boris.unibe.ch/id/eprint/150765

Actions (login required)

Edit item Edit item
Provide Feedback