Deep brain stimulation with double targeting of the VIM and PSA for the treatment of rare tremor syndromes

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dc.authorid0000-0002-1081-3545en_US
dc.authorscopusid55346538900en_US
dc.authorwosidU-2820-2018en_US
dc.contributor.authorYılmaz, Atilla
dc.contributor.authorEray, Halit Anıl
dc.contributor.authorÇakır, Murtaza
dc.contributor.authorCeylan, Mustafa
dc.contributor.authorBlomstedt, Patric
dc.date.accessioned2024-07-02T06:05:14Z
dc.date.available2024-07-02T06:05:14Z
dc.date.issued2024en_US
dc.departmentFakülteler, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Beyin Cerrahisi Ana Bilim Dalıen_US
dc.description.abstractIntroduction: In tremor syndromes, pharmacological therapy is the primary treatment, but deep brain stimulation (DBS) is used when it is insufficient. We explore the use of DBS, focusing on the globus pallidus internus for dystonia and the ventral intermediate nucleus (VIM) for tremor conditions. We introduce the posterior subthalamic area (PSA) as a potential target, suggesting its efficacy in tremor reduction, particularly in rare tremor syndromes. We aim to evaluate the efficacy and safety of double targeting the VIM and PSA in rare tremor conditions, highlighting the limited existing data on this. Methods: Between 2019 and 2023, 22 patients with rare tremor syndromes were treated with bilateral DBS of the VIM and PSA. This case series consisted of 7 isolated head tremor, 1 hepatic encephalopathic tremor due to Abernethy syndrome, 2 voice tremor, 4 dystonic tremor, and 8 Holmes tremor (2 multiple sclerosis, 2 cerebellar insult, and 4 posttraumatic) patients. Patients' preoperative and 12-month postoperative tremor scores were compared, and the optimum VIM and PSA stimulation areas were investigated. Results: There was a significant reduction in the mean TRS score from 3.70 (±0.57) to 0.45 (±0.68) after 12 months of surgery. Specific outcomes for different indications were observed: for head tremor, 6 of 7 patients showed a reduction in TRS scores to 0 points; the vocal tremor patients demonstrated improvement; this change was not statistically significant, which is likely to be due to the low number of patients in this subgroup; the dystonic tremor patients showed either complete tremor abolition or a reduction in TRS scores; the Holmes tremor patients showed an 80% reduction in TRS scores; and the hepatic encephalopathy tremor and Abernethy syndrome patients showed a 75% improvement in TRS scores. The stimulation parameters converged on the VIM and dorsal PSA. Complications included the need for electrode repositioning, infections requiring electrode removal and re-implantation, dysarthria, and stimulation-induced ataxia, which was resolved by adjusting the stimulation parameters. Discussion: The literature on DBS for rare tremors is limited. Double targeting of the VIM and PSA appears to produce promising improvements on the outcomes reported in the existing literature on VIM-only DBS. The proximity of the VIM and PSA allows for flexible electrode placement, contributing to the potential success of the dual-target approach. We also discuss the theoretical advantages of targeting the PSA based on the distribution of tremor circuits, emphasizing the need for further research and electrophysiological studies.en_US
dc.identifier.citationYılmaz, A., Eray, H. A., Çakır, M., Ceylan, M. & Blomstedt, P. (2024). Deep brain stimulation with double targeting of the VIM and PSA for the treatment of rare tremor syndromes. Stereotactic and Functional Neurosurgery, 102(4), pp. 224-239. https://doi.org/10.1159/000539162en_US
dc.identifier.doi10.1159/000539162en_US
dc.identifier.endpage239en_US
dc.identifier.issn1011-6125
dc.identifier.issn1423-0372
dc.identifier.issue4en_US
dc.identifier.pmidPMID: 38934181en_US
dc.identifier.scopus2-s2.0-85197755675en_US
dc.identifier.scopusqualityQ2en_US
dc.identifier.startpage224en_US
dc.identifier.urihttps://hdl.handle.net/20.500.13055/723
dc.identifier.urihttps://doi.org/10.1159/000539162en_US
dc.identifier.volume102en_US
dc.identifier.wosWOS:001258531100001en_US
dc.identifier.wosqualityQ2en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.indekslendigikaynak.otherSCI-E - Science Citation Index Expandeden_US
dc.institutionauthorYılmaz, Atilla
dc.language.isoenen_US
dc.publisherKargeren_US
dc.relation.ispartofStereotactic and Functional Neurosurgeryen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectDeep Brain Stimulationen_US
dc.subjectDouble Targetingen_US
dc.subjectPosterior Subthalamic Areaen_US
dc.subjectThalamusen_US
dc.subjectTremor Syndromesen_US
dc.titleDeep brain stimulation with double targeting of the VIM and PSA for the treatment of rare tremor syndromesen_US
dc.typeArticleen_US
dspace.entity.typePublication

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