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. 2023 Mar 31;10(5):783-793.
doi: 10.1002/mdc3.13729. eCollection 2023 May.

10 Years Follow-Up of Deep Brain Stimulation in the Caudal Zona Incerta/Posterior Subthalamic Area for Essential Tremor

Yulia Blomstedt  1   2 , Rasmus Stenmark Persson  2 , Amar Awad  2   3 , Gun-Marie Hariz  2 , Johanna Philipson  2 , Marwan Hariz  2   4 , Anders Fytagoridis  5 , Patric Blomstedt  2
Affiliations

10 Years Follow-Up of Deep Brain Stimulation in the Caudal Zona Incerta/Posterior Subthalamic Area for Essential Tremor

Yulia Blomstedt et al. Mov Disord Clin Pract. .

Abstract

Background: Long-term data on the effects of deep brain stimulation (DBS) for essential tremor (ET) is scarce, especially regarding DBS in the caudal Zona incerta (cZi) and the posterior subthalamic area (PSA).

Objectives: The aim of this prospective study was to evaluate the effect of cZi/PSA DBS in ET at 10 years after surgery.

Methods: Thirty-four patients were included. All patients received cZi/PSA DBS (5 bilateral/29 unilateral) and were evaluated at regular intervals using the essential tremor rating scale (ETRS).

Results: One year after surgery, there was a 66.4% improvement of total ETRS and 70.7% improvement of tremor (items 1-9) compared with the preoperative baseline. Ten years after surgery, 14 patients had died and 3 were lost to follow-up. In the remaining 17 patients, a significant improvement was maintained (50.8% for total ETRS and 55.8% for tremor items). On the treated side the scores of hand function (items 11-14) had improved by 82.6% at 1 year after surgery, and by 66.1% after 10 years. Since off-stimulation scores did not differ between year 1 and 10, this 20% deterioration of on-DBS scores was interpreted as a habituation. There was no significant increase in stimulation parameters beyond the first year.

Conclusions: This 10 year follow up study, found cZi/PSA DBS for ET to be a safe procedure with a mostly retained effect on tremor, compared to 1 year after surgery, and in the absence of increase in stimulation parameters. The modest deterioration of effect of DBS on tremor was interpreted as habituation.

Keywords: DBS; essential tremor; long‐term follow‐up; posterior subthalamic area; zona incerta.

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Figures

Figure 1
Figure 1
Preoperative T2 MRI fused with postoperative CT demonstrating the leads in the caudal zona incerta (cZi) within the posterior subthalamic area (PSA), posteromedial to the subthalamic nucleus (STN) at the level of the maximal diameter of the red nucleus (Rn)
Figure 2
Figure 2
Mean total ETRS scores among participants and dropouts on and off stimulation at different evaluation time points
Figure 3
Figure 3
Mean scores for Total Essential Tremor Rating Scale (ETRS), tremor (items 1–9) and hand function (items 11–14) at different evaluations on and off stimulation (with error bars). Numbers between brackets indicate the number of patients at each evaluation time point
Figure 4
Figure 4
Change in ETRS scores during 10 years of follow‐up in unilaterally implanted patients
Figure 5
Figure 5
Mean scores for Total Essential Tremor Rating Scale (ETRS), tremor (items 1–9) and hand function (items 11–14) at different evaluations on and off stimulation in uni‐ and bilaterally implanted patients
See this image and copyright information in PMC

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