Deep brain stimulation of the vim nucleus of the thalamus for the treatment of tremor

• Published in: Neurology Vol. 55; no. 12; pp. S29 - S33
• Main Authors: KOLLER, William C, PAHWA, Rajesh, LYONS, Kelly E, WILKINSON, Steven B
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 2000
• Subjects: Biological and medical sciences; Electric Stimulation Therapy - methods; Humans; Medical sciences; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Parkinson Disease - physiopathology; Parkinson Disease - therapy; Ventral Thalamic Nuclei - physiopathology; Human; Instrumental stimulation; Nervous system diseases; Treatment; Tremor; Ventromedial nucleus; Instrumentation therapy; Thalamus; Neurological disorder; Involuntary movement; Brain (vertebrata)
• ISSN: 0028-3878; 1526-632X

The surgical treatment of tremor has evolved considerably in the past few years. Of the several conditions associated with severe tremor, the most common are Parkinson's disease (PD) and essential tremor (ET). Levodopa therapy reduced drastically the number of patients with PD who require surgery because of inadequate control. However, there remains a small number of "tremor dominant" PD patients for whom surgical treatment is often the best option. The ventralis intermediate nucleus (Vim) of the thalamus has been the preferred surgical target for the treatment of parkinsonian tremor for many years, but this is now challenged by the subthalamic nucleus (STN). Deep brain stimulation (DBS) of either target possesses high therapeutic efficacy against tremor in PD. ET may be difficult to treat pharmacologically. Thalamotomy is an effective surgical procedure for ameliorating ET but may be associated with persistent neurologic deficits. DBS of the thalamus is also a highly effective means of reducing ET. DBS appears to be safer than thalamotomy and is now the recommended surgical procedure.