Session Information
Date: Monday, June 5, 2017
Session Title: Surgical Therapy: Parkinson’s Disease
Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: To analyze the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on cranial tremor in Parkinson’s disease (PD).
Background: STN DBS has been shown to improve appendicular tremors significantly. While bilateral thalamic (VIM) DBS has shown some benefit in essential tremor, little is known of improvement in cranial tremor with bilateral STN DBS. A study of 13 patients with essential tremor found that bilateral thalamic DBS was more effective than unilateral DBS at controlling appendicular and midline tremors.
Methods: We utilized a secure electronic DBS database to search all PD patients who have undergone DBS of bilateral STN at University Hospitals Cleveland Medical Center and analyzed changes in cranial tremor from the UPDRS pre and post DBS. We compared the numerical value of cranial tremor documented on the UPDRS immediately before surgery as well as 3 and 6 months after surgery. We excluded patients with unilateral STN DBS, or those patients who have had undergone DBS lead replacement surgery.
Results: We analyzed 71 PD patients who underwent bilateral STN DBS. 20/71 (28.2%) patients were found to have had cranial tremor prior to DBS. 20/71 patients (85%) showed an improvement in cranial tremor 3 and 6 months after DBS. Two (10%) patients were noted to have had the same intensity cranial tremor pre and post DBS. One (5%) patient’s cranial tremor was noted to be worse at 3 and 6 months after DBS. Three (4.2%) patients developed a cranial tremor at 6 months post DBS. Sub analysis data is being collected for positioning of DBS lead contacts to better understand the anatomical location at which cranial tremors show the most optimal improvement.
Conclusions: The majority of PD patients who had pre-surgical cranial tremor improved after DBS. The likely explanation for tremor development after DBS is disease progression. Further knowledge on cranial tremor improvement from STN DBS can assist physicians in counseling patients regarding likely benefit from DBS. Our next step is to compare lead placement with those patients that had cranial tremor improvement versus no cranial tremor improvement.
References:
- Ondo W, Almaguer M, Jankovic J, Simpson RK. Thalamic deep brain stimulation: comparison between unilateral and bilateral placement. Arch Neurol. 2001 Feb;58(2):218-22.
To cite this abstract in AMA style:
L. Cameron, C. Kilbane, A. Shaikh. Effect of deep brain stimulation of the subthalamic nucleus on cranial tremor in Parkinson’s disease [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/effect-of-deep-brain-stimulation-of-the-subthalamic-nucleus-on-cranial-tremor-in-parkinsons-disease/. Accessed June 15, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-deep-brain-stimulation-of-the-subthalamic-nucleus-on-cranial-tremor-in-parkinsons-disease/