Continue elektrische thalamusstimulatie voor de behandeling van farmacotherapie-resistente tremor

To determine the efficacy of continuous electrical thalamic stimulation in the treatment of pharmacotherapy-resistant tremor in patients with Parkinson's disease and essential tremor.

Design

Descriptive study.

Setting

Academic Medical Centre, Academic Hospital of the University of Amsterdam.

Method

Five patients with Parkinson's disease and one with familial essential tremor suffering from pharmacotherapy-resistant tremor were treated by implantation of a four-polar stimulation electrode in the contralateral ventrolateral thalamic nucleus connected subcutaneously to a stimulator. Continuous electrical stimulation was applied in the daytime and switched off during the night. Three of the Parkinson patients were subjected to contralateral thalamotomy as well.

Results

Three patients (including the one with essential tremor) had complete tremor suppression during stimulation, and the other three had intermittent minimal tremor. There were no early complications (follow-up: 1 month-1 year). One patient had mild hemi-inattention and pyramidal signs due to the thalamotomy.

Conclusion

Continuous thalamic stimulation appears to be a good alternative to thalamotomy. It renders possible bilateral surgical treatment for severe bilateral tremor.