Long-term efficacy of deep brain stimulation for essential tremor
| العنوان: | Long-term efficacy of deep brain stimulation for essential tremor |
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| المؤلفون: | Steffen Paschen, Helge Hellriegel, Jos Steffen Becktepe, Günther Deuschl, Ann-Kristin Helmers, Sebastian Heinzel, Karsten Witt, Julia Forstenpointner |
| المصدر: | Neurology. 92:e1378-e1386 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | Male, 0301 basic medicine, Time Factors, Deep brain stimulation, Activities of daily living, Deep Brain Stimulation, Essential Tremor, medicine.medical_treatment, Drug Resistance, Stimulation, Severity of Illness Index, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Rating scale, Accelerometry, medicine, Humans, Single-Blind Method, Aged, Essential tremor, business.industry, Archimedean spiral, medicine.disease, Treatment Outcome, 030104 developmental biology, Anesthesia, Disease Progression, Thalamic nucleus, symbols, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Follow-Up Studies, Blinded study |
| الوصف: | ObjectiveDeep brain stimulation (DBS) of the ventral intermediate thalamic nucleus (Vim) is established for medically refractory severe essential tremor (ET), but long-term efficacy is controversial.MethodsTwenty patients with ET with DBS had standardized video-documented examinations at baseline, in the stimulation-on condition at short term (13.1 ± 1.9 months since surgery, mean ± SEM), and in the stimulator switched on and off (stim-ON/OFF) at long term; all assessments were done between 32 and 120 months (71.9 ± 6.9 months) after implantation. The primary outcome was the Tremor Rating Scale (TRS) blindly assessed by 2 trained movement disorder neurologists. Secondary outcomes were TRS subscores A, B, and C; Archimedes spiral score; and activities of daily living score. At long-term follow-up, tremor was additionally recorded with accelerometry. The rebound effect after switching the stimulator off was assessed for 1 hour in a subgroup.ResultsTremor severity worsened considerably over time in both in the nonstimulated and stimulated conditions. Vim-DBS improved the TRS in the short term and long term significantly. The spiral score and functional measures showed similar improvements. All changes were highly significant. However, the stimulation effect was negatively correlated with time since surgery (ρ = −0.78, p < 0.001). This was also true for the secondary outcomes. Only one-third of the patients had a rebound effect terminated 60 minutes after the stimulator was switched off. Long-term worsening of the TRS was more profound during stim-ON than in the stim-OFF condition, indicating habituation to stimulation.ConclusionVim-DBS loses efficacy over the long term. Efforts are needed to improve the long-term efficacy of Vim-DBS.Classification of evidenceThis study provides Class IV evidence that for patients with medically refractory severe ET, the efficacy of Vim-DBS severely decreases over 10 years. |
| تدمد: | 1526-632X 0028-3878 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6908dd7984fdd4323b647314a7464d99Test https://doi.org/10.1212/wnl.0000000000007134Test |
| رقم الانضمام: | edsair.doi.dedup.....6908dd7984fdd4323b647314a7464d99 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1526632X 00283878 |
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