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 language | English (US) |
|---|---|
| Article number | 46 |
| Pages (from-to) | 1-7 |
| Number of pages | 7 |
| Journal | Tremor and Other Hyperkinetic Movements |
| Volume | 10 |
| DOIs | |
| State | Published - 2020 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2020 The Author(s).
Keywords
- Brain atrophy
- Deep brain stimulation (DBS)
- Essential tremor (ET)
- Lead shift
- Ventralis intermedius nucleus (VIM)