Combined Deep Brain Stimulation of Subthalamic Nucleus and Ventral Intermediate Thalamic Nucleus in Tremor‐Dominant Parkinson's Disease Using a Parietal Approach

摘要

Objectives Despite its efficacy in tremor‐suppression, the ventral intermediate thalamic (VIM) nucleus has largely been neglected in deep brain stimulation (DBS) for tremor‐dominant Parkinson's disease (tdPD). The employment of a parietal approach, however, allows stimulation of VIM and subthalamic nucleus (STN) using one trajectory only and thus constitutes a promising alternative to existing strategies. In the present study, we investigate safety and efficacy of combined lead implantation and stimulation of STN and VIM using a parietal approach. Materials and Methods Retrospective analysis of five patients with tdPD was performed who underwent DBS using a parietal approach. Changes in symptom severity, disease‐specific health‐related quality of life and l ‐dopa equivalent doses (LED) were evaluated over a total time course of 12?months. Results DBS within both targets yielded significant improvement of parkinsonian symptoms (median: 40.0%, p ?=?0.04) in the first 6 months of continuous stimulation and remained stable thereafter (median improvement at 12?months: 43.2%, p ?=?0.07). Sustained improvement of tremor (median at 6 months: 100.0%, p ?=?0.04; median at 12?months 83.3%, p ?=?0.04) and quality of life scores (median at 6 months: 29.8%, p ?=?0.04; median at 12?months: 32.6%, p ?=?0.04) was noted throughout the follow‐up period. No significant change of LEDs was observed by the end of follow‐up (median decrease: 2.2%, p ?=?0.89). Conclusions Simultaneous DBS of VIM and STN using one trajectory is safe, yielding good control of parkinsonian tremors. Further studies, however, are necessary to determine whether a parietal trajectory affords better control over tremor symptoms than established strategies and hence justifies the potential risks associated with the alternative approach.