Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus in Medically Refractory Orthostatic Tremor : Preliminary Observations
Identifieur interne : 003903 ( Main/Merge ); précédent : 003902; suivant : 003904Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus in Medically Refractory Orthostatic Tremor : Preliminary Observations
Auteurs : Alberto J. Espay [États-Unis] ; Andrew P. Duker [États-Unis] ; Robert Chen [Canada] ; Michael S. Okun [États-Unis] ; Edwin T. Barrett [États-Unis] ; Johnna Devoto [États-Unis] ; Pamela Zeilman [États-Unis] ; Maureen Gartner [États-Unis] ; Noël Burton [États-Unis] ; Helard A. Miranda [États-Unis] ; George T. Mandybur [États-Unis] ; Theresa A. Zesiewicz [États-Unis] ; Kelly D. Foote [États-Unis] ; Fredy J. Revilla [États-Unis]Source :
- Movement disorders [ 0885-3185 ] ; 2008.
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Abstract
Orthostatic tremor (OT) is a disabling movement disorder associated with postural and gait impairment in the elderly. Medical therapy often yields insufficient benefit. We report the clinical and electrophysiological data on two patients with medication-refractory OT treated with deep brain stimulation of the ventral intermediate thalamic nucleus (Vim DBS). Patient 1 underwent bilateral deep brain stimulation (DBS) and Patient 2 unilateral Vim DBS following 28 and 30 years of disease duration, respectively. Both patients showed increased latency to symptom onset after rising from a seated position, improved tolerance for prolonged standing, and slower crescendo of tremor severity when remaining upright. Postoperative evaluation demonstrated decreased amplitude of electromyographic activity with persistence of well-defined oscillatory behavior showing strong coherence at 15 Hz between all muscles tested in the upper and lower limbs. Postural sway was unchanged. Clinical benefits have been sustained for over 18 months in Patient 1, and receded after 3 months in Patient 2. These findings support the consideration of bilateral Vim DBS implantation as a therapeutic option in patients with medically refractory OT. Further efficacy studies on chronic stimulation to disrupt the abnormal oscillatory activity in this disorder are warranted.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus in Medically Refractory Orthostatic Tremor : Preliminary Observations</title><author><name sortKey="Espay, Alberto J" sort="Espay, Alberto J" uniqKey="Espay A" first="Alberto J." last="Espay">Alberto J. Espay</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Duker, Andrew P" sort="Duker, Andrew P" uniqKey="Duker A" first="Andrew P." last="Duker">Andrew P. Duker</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Toronto Western Research Institute, Toronto Western Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Neurology, Department of Medicine, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Okun, Michael S" sort="Okun, Michael S" uniqKey="Okun M" first="Michael S." last="Okun">Michael S. Okun</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Department of Neurology, McKnight Brain Institute, Movement Disorders Center, University of Florida College of Medicine</s1><s2>Gainesville, Florida</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Barrett, Edwin T" sort="Barrett, Edwin T" uniqKey="Barrett E" first="Edwin T." last="Barrett">Edwin T. Barrett</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Devoto, Johnna" sort="Devoto, Johnna" uniqKey="Devoto J" first="Johnna" last="Devoto">Johnna Devoto</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Zeilman, Pamela" sort="Zeilman, Pamela" uniqKey="Zeilman P" first="Pamela" last="Zeilman">Pamela Zeilman</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Department of Neurology, McKnight Brain Institute, Movement Disorders Center, University of Florida College of Medicine</s1><s2>Gainesville, Florida</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Gartner, Maureen" sort="Gartner, Maureen" uniqKey="Gartner M" first="Maureen" last="Gartner">Maureen Gartner</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Burton, Noel" sort="Burton, Noel" uniqKey="Burton N" first="Noël" last="Burton">Noël Burton</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Miranda, Helard A" sort="Miranda, Helard A" uniqKey="Miranda H" first="Helard A." last="Miranda">Helard A. Miranda</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Mandybur, George T" sort="Mandybur, George T" uniqKey="Mandybur G" first="George T." last="Mandybur">George T. Mandybur</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Zesiewicz, Theresa A" sort="Zesiewicz, Theresa A" uniqKey="Zesiewicz T" first="Theresa A." last="Zesiewicz">Theresa A. Zesiewicz</name><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Department of Neurology, University of South Florida</s1><s2>Tampa, Florida</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Floride</region><settlement type="city">Tampa</settlement></placeName><orgName type="university">Université de Floride du Sud</orgName></affiliation></author><author><name sortKey="Foote, Kelly D" sort="Foote, Kelly D" uniqKey="Foote K" first="Kelly D." last="Foote">Kelly D. Foote</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Department of Neurology, McKnight Brain Institute, Movement Disorders Center, University of Florida College of Medicine</s1><s2>Gainesville, Florida</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Revilla, Fredy J" sort="Revilla, Fredy J" uniqKey="Revilla F" first="Fredy J." last="Revilla">Fredy J. Revilla</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">09-0058900</idno><date when="2008">2008</date><idno type="stanalyst">PASCAL 09-0058900 INIST</idno><idno type="RBID">Pascal:09-0058900</idno><idno type="wicri:Area/PascalFrancis/Corpus">001035</idno><idno type="wicri:Area/PascalFrancis/Curation">001C84</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">001295</idno><idno type="wicri:doubleKey">0885-3185:2008:Espay A:deep:brain:stimulation</idno><idno type="wicri:Area/Main/Merge">003903</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus in Medically Refractory Orthostatic Tremor : Preliminary Observations</title><author><name sortKey="Espay, Alberto J" sort="Espay, Alberto J" uniqKey="Espay A" first="Alberto J." last="Espay">Alberto J. Espay</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Duker, Andrew P" sort="Duker, Andrew P" uniqKey="Duker A" first="Andrew P." last="Duker">Andrew P. Duker</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Toronto Western Research Institute, Toronto Western Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Neurology, Department of Medicine, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Okun, Michael S" sort="Okun, Michael S" uniqKey="Okun M" first="Michael S." last="Okun">Michael S. Okun</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Department of Neurology, McKnight Brain Institute, Movement Disorders Center, University of Florida College of Medicine</s1><s2>Gainesville, Florida</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Barrett, Edwin T" sort="Barrett, Edwin T" uniqKey="Barrett E" first="Edwin T." last="Barrett">Edwin T. Barrett</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Devoto, Johnna" sort="Devoto, Johnna" uniqKey="Devoto J" first="Johnna" last="Devoto">Johnna Devoto</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Zeilman, Pamela" sort="Zeilman, Pamela" uniqKey="Zeilman P" first="Pamela" last="Zeilman">Pamela Zeilman</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Department of Neurology, McKnight Brain Institute, Movement Disorders Center, University of Florida College of Medicine</s1><s2>Gainesville, Florida</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Gartner, Maureen" sort="Gartner, Maureen" uniqKey="Gartner M" first="Maureen" last="Gartner">Maureen Gartner</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Burton, Noel" sort="Burton, Noel" uniqKey="Burton N" first="Noël" last="Burton">Noël Burton</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Miranda, Helard A" sort="Miranda, Helard A" uniqKey="Miranda H" first="Helard A." last="Miranda">Helard A. Miranda</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Mandybur, George T" sort="Mandybur, George T" uniqKey="Mandybur G" first="George T." last="Mandybur">George T. Mandybur</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Zesiewicz, Theresa A" sort="Zesiewicz, Theresa A" uniqKey="Zesiewicz T" first="Theresa A." last="Zesiewicz">Theresa A. Zesiewicz</name><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Department of Neurology, University of South Florida</s1><s2>Tampa, Florida</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Floride</region><settlement type="city">Tampa</settlement></placeName><orgName type="university">Université de Floride du Sud</orgName></affiliation></author><author><name sortKey="Foote, Kelly D" sort="Foote, Kelly D" uniqKey="Foote K" first="Kelly D." last="Foote">Kelly D. Foote</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Department of Neurology, McKnight Brain Institute, Movement Disorders Center, University of Florida College of Medicine</s1><s2>Gainesville, Florida</s2><s3>USA</s3><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Revilla, Fredy J" sort="Revilla, Fredy J" uniqKey="Revilla F" first="Fredy J." last="Revilla">Fredy J. Revilla</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Department of Neurology, The Neuroscience Institute, Movement Disorders Center, University of Cincinnati</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Deep brain stimulation</term><term>Nervous system diseases</term><term>Refractory</term><term>Thalamus</term><term>Tremor</term><term>Ventral nucleus</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Tremblement</term><term>Pathologie du système nerveux</term><term>Noyau ventral</term><term>Thalamus</term><term>Réfractaire</term><term>Stimulation cérébrale profonde</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Orthostatic tremor (OT) is a disabling movement disorder associated with postural and gait impairment in the elderly. Medical therapy often yields insufficient benefit. We report the clinical and electrophysiological data on two patients with medication-refractory OT treated with deep brain stimulation of the ventral intermediate thalamic nucleus (Vim DBS). Patient 1 underwent bilateral deep brain stimulation (DBS) and Patient 2 unilateral Vim DBS following 28 and 30 years of disease duration, respectively. Both patients showed increased latency to symptom onset after rising from a seated position, improved tolerance for prolonged standing, and slower crescendo of tremor severity when remaining upright. Postoperative evaluation demonstrated decreased amplitude of electromyographic activity with persistence of well-defined oscillatory behavior showing strong coherence at 15 Hz between all muscles tested in the upper and lower limbs. Postural sway was unchanged. Clinical benefits have been sustained for over 18 months in Patient 1, and receded after 3 months in Patient 2. These findings support the consideration of bilateral Vim DBS implantation as a therapeutic option in patients with medically refractory OT. Further efficacy studies on chronic stimulation to disrupt the abnormal oscillatory activity in this disorder are warranted.</div></front></TEI><affiliations><list><country><li>Canada</li><li>États-Unis</li></country><region><li>Floride</li><li>Ohio</li><li>Ontario</li></region><settlement><li>Tampa</li><li>Toronto</li></settlement><orgName><li>Université de Floride du Sud</li><li>Université de Toronto</li></orgName></list><tree><country name="États-Unis"><region name="Ohio"><name sortKey="Espay, Alberto J" sort="Espay, Alberto J" uniqKey="Espay A" first="Alberto J." last="Espay">Alberto J. Espay</name></region><name sortKey="Barrett, Edwin T" sort="Barrett, Edwin T" uniqKey="Barrett E" first="Edwin T." last="Barrett">Edwin T. Barrett</name><name sortKey="Burton, Noel" sort="Burton, Noel" uniqKey="Burton N" first="Noël" last="Burton">Noël Burton</name><name sortKey="Devoto, Johnna" sort="Devoto, Johnna" uniqKey="Devoto J" first="Johnna" last="Devoto">Johnna Devoto</name><name sortKey="Duker, Andrew P" sort="Duker, Andrew P" uniqKey="Duker A" first="Andrew P." last="Duker">Andrew P. Duker</name><name sortKey="Foote, Kelly D" sort="Foote, Kelly D" uniqKey="Foote K" first="Kelly D." last="Foote">Kelly D. Foote</name><name sortKey="Gartner, Maureen" sort="Gartner, Maureen" uniqKey="Gartner M" first="Maureen" last="Gartner">Maureen Gartner</name><name sortKey="Mandybur, George T" sort="Mandybur, George T" uniqKey="Mandybur G" first="George T." last="Mandybur">George T. Mandybur</name><name sortKey="Miranda, Helard A" sort="Miranda, Helard A" uniqKey="Miranda H" first="Helard A." last="Miranda">Helard A. Miranda</name><name sortKey="Okun, Michael S" sort="Okun, Michael S" uniqKey="Okun M" first="Michael S." last="Okun">Michael S. Okun</name><name sortKey="Revilla, Fredy J" sort="Revilla, Fredy J" uniqKey="Revilla F" first="Fredy J." last="Revilla">Fredy J. Revilla</name><name sortKey="Zeilman, Pamela" sort="Zeilman, Pamela" uniqKey="Zeilman P" first="Pamela" last="Zeilman">Pamela Zeilman</name><name sortKey="Zesiewicz, Theresa A" sort="Zesiewicz, Theresa A" uniqKey="Zesiewicz T" first="Theresa A." last="Zesiewicz">Theresa A. Zesiewicz</name></country><country name="Canada"><noRegion><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name></noRegion><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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