Brain atrophy following deep brain stimulation: Management of a moving target

Shannon Y. Chiu, Wissam Deeb, Pamela Zeilman, Adolfo Ramirez-Zamora, Addie Patterson, Bhavana Patel, Kelly D. Foote, Michael S. Okun, Amar Patel, Leonardo Almeida

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Clinical vignette: A 51-year-old man with essential tremor (ET) had bilateral ventralis intermedius nucleus deep brain stimulation (VIM-DBS) placed to address refractory tremor. Despite well-placed DBS leads and adequate tremor response, he subsequently experienced worsening. Re-programming of the device and reconfirming the electrical thresholds for benefits and side effects were both performed. Six years following DBS implanta-tion, repeat imaging revealed brain atrophy and a measured lead position change with a coincident change in clinical response. Clinical dilemma: What do we know about brain atrophy affecting lead placement and long-term DBS effec-tiveness? What are the potential strategies to combat narrowed therapeutic thresholds and to maximize DBS therapeutic benefit? Clinical solution: Decreasing the electrical field of stimulation and programming in a bipolar configuration are strategies to provide symptomatic tremor control and to minimize stimulation-induced side effects. Gaps in knowledge: Currently, effects of brain atrophy, and factors underpinning emergence of side effects and/or loss of benefit in chronic VIM-DBS remain largely unexplored.

Original languageEnglish (US)
Article number46
Pages (from-to)1-7
Number of pages7
JournalTremor and Other Hyperkinetic Movements
Volume10
DOIs
StatePublished - 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 The Author(s).

Keywords

  • Brain atrophy
  • Deep brain stimulation (DBS)
  • Essential tremor (ET)
  • Lead shift
  • Ventralis intermedius nucleus (VIM)

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