Deep Brain Stimulation for Essential Tremor: A Systematic Review

Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Stepney, South Australia, Australia.
Movement Disorders (Impact Factor: 5.68). 08/2010; 25(11):1550-9. DOI: 10.1002/mds.23195
Source: PubMed


Deep brain stimulation (DBS) is a neurosurgical treatment, which has proven useful in treating Parkinson's disease. This systematic review assessed the safety and effectiveness of DBS for another movement disorder, essential tremor. All studies concerning the use of DBS in patients with essential tremor were identified through searching of electronic databases and hand searching of reference lists. Studies were categorized as before/after DBS or DBS stimulation on/off to allow the effect of the stimulation to be analyzed separately to that of the surgery itself. A total of 430 patients who had received DBS for essential tremor were identified. Most of the reported adverse events were mild and could be treated through changing the stimulation settings. Generally, in all studies, there was a significant improvement in outcomes after DBS compared with baseline scores. In addition, DBS was significantly better in testing when the stimulation was turned on, compared with stimulation turned off or baseline. Based on Level IV evidence, DBS is possibly a safe and effective therapy for essential tremor.

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    • "Alternatively, CT of investigation is whether DBS may be a potent therapeutics for disorders of learning and memory. Several studies have demonstrated that thalamic DBS is a safe and efficacious treatment for essential tremor (Flora et al., 2010;Baizabal Carvallo et al., 2011). It has also been reported that DBS at CT (CT-DBS) enhanced exploratory motor behaviors and cognitive performance through neocortical and hippocampal neuronal activation by specific regulation of c- Fos and immediate-early gene–encoded protein Egr-1 (zif268) expressions in normal rats (Shirvalkar et al., 2006). "
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    ABSTRACT: Central thalamic deep brain stimulation (CT-DBS) has been proposed as an experimental therapeutic approach to produce consistent sustained regulation of forebrain arousal for several neurological diseases. We investigated local field potentials (LFPs) induced by CT-DBS from the thalamic central lateral nuclei (CL) and the striatum as potential biomarkers for the enhancement of lever-pressing skill learning. LFPs were simultaneously recorded from multiple sites in the CL, ventral striatum (Vstr), and dorsal striatum (Dstr). LFP oscillation power and functional connectivity were assessed and compared between the CT-DBS and sham control groups. The theta and alpha LFP oscillations were significantly increased in the CL and striatum in the CT-DBS group. Furthermore, interhemispheric coherences between bilateral CL and striatum were increased in the theta band. Additionally, enhancement of c-Fos activity, dopamine D2 receptor (Drd2) and 4-nicotinic acetylcholine receptor (4-nAChR) occurred after CT-DBS treatment in the striatum and hippocampus. CT-DBS strengthened thalamic-striatal functional connectivity, which demonstrates that the inter-regional connectivity enhancement might contribute to synaptic plasticity in the striatum. Altered dopaminergic and cholinergic receptors resulted in modulation of striatal synaptic plasticity’s ability to regulate downstream signaling cascades for higher brain functions of lever-pressing skill learning.
    Full-text · Article · Jan 2016 · Frontiers in Neural Circuits
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    • "However, these patients report that stimulation has a deleterious effect on their speech, inducing a severe impact on quality of life and social functioning. And indeed, in the literature stimulation induced dysarthria is reported as being a common side effect affecting between 10% and 75% of patients [4]. Previous studies on VIM-DBS in patients with multiple sclerosis [5] and essential tremor [6] have shown a detrimental effect of stimulation on the speech when looking at the subsyllabic level. "
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    ABSTRACT: The present study is the first kinematic study to investigate the speech production of ET patients with VIM-DBS. More specifically, it explores the coordination patterns of articulatory gestures in syllables with simple and complex onsets, CV and CCV, in German. It provides a preliminary analysis of gestural coordination under stimulation for the target words /lima/ and /klima/ in the framework of Articulatory Phonology. The findings reveal a timing deficit in the phonetic realization of competing coupling relations for complex onsets for the patients. The observed perturbation of gestural phase relations can be related to the coupling hypothesis of syllable structure and are taken to be a symptom for dysarthria.
    Full-text · Conference Paper · Aug 2015
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    • "The open-loop strategies may involve the machine-learning of the algorithm parameters or changing the algorithm parameters based on the patient's performance (slow-time scale); however, these strategies do not change stimulation parameters on a pulse-by-pulse basis in response to the evoked activity (fast-time scale), i.e., the level of stimulation does not change in response to any continuous measurement of the level of neural activity that is generated. While many stimulation strategy algorithms in bionic devices have been successful using open-loop techniques [5] [11] [25], the outcomes differ from patient to patient [1] [8] [27] [36] [43]. For example, the benefits of the cochlear implant may vary even among patients with similar otologic pathologies and with the same type of the cochlear implant system [36]. "
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    ABSTRACT: Currently, open-loop stimulation strategies are prevalent in medical bionic devices. These strategies involve setting electrical stimulation that does not change in response to neural activity. We investigate through simulation the advantages of using a closed-loop strategy that sets stimulation level based on continuous measurement of the level of neural activity. We propose a model-based controller design to control activation of retinal neurons. To deal with the lack of controllability and observability of the whole system, we use Kalman decomposition and control only the controllable and observable part. We show that the closed-loop controller performs better than the open-loop controller when perturbations are introduced into the system. We envisage that our work will give rise to more investigations of the closed-loop techniques in basic neuroscience research and in clinical applications of medical bionics.
    Full-text · Article · Nov 2014 · Biomedical Signal Processing and Control
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