Long-term electrical inhibition of deep brain targets in movement disorders
Mov. Disord.. 2008-10-20; 13(S3): 119-125
DOI: 10.1002/mds.870131321
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1. Mov Disord. 1998;13 Suppl 3:119-25. doi: 10.1002/mds.870131321.
Long-term electrical inhibition of deep brain targets in movement disorders.
Benabid AL(1), Benazzouz A, Hoffmann D, Limousin P, Krack P, Pollak P.
Author information:
(1)Department of Clinical and Biological Neurosciences, INSERM Preclinical
Neurobiology, Joseph Fourier University of Grenoble, Hôpital A. Michallon,
France.
Stimulation of the thalamic nucleus ventralis intermedius (Vim) at high (130-Hz)
frequency has been used over the last 8 years as a treatment in 134 patients
with movement disorders (91 Parkinson’s disease [PD], 23 essential tremor [ET],
21 various dyskinesias and dystonias, including four multiple sclerosis [MS]),
implanted with long-term electrodes connected to a programmable stimulator. In
PD patients, tremor was selectively suppressed for < or = 11 years. In ET
patients, results were satisfactory, but in 35% of the cases deteriorated with
time, when tremor had an action component. Other types of dyskinesias were much
less influenced. Sixty-eight patients were bilaterally implanted, and 14 were
implanted contralateral to a previous thalamotomy. Side effects were often
minor, well tolerated, and immediately reversible. Three secondary scalp
infections led to temporary removal of implanted material. There was no
permanent morbidity. Long-term Vim stimulation, which is reversible, adaptable,
and well tolerated, even by bilaterally operated-on (68 of 134) and by elderly
patients, should replace thalamotomy in the regular surgical treatment of
parkinsonian and essential tremors. More recently, we stimulated the subthalamic
nucleus (STN) in 51 patients (44 bilateral) and the globus pallidus internus
(GPi) in 12 patients (seven bilateral). STN stimulation has a spectacular effect
on akinesia and rigidity and may improve the patients so as to maintain them all
day at a level similar to their best "on" periods. A 30-50% reduction in drug
dosage was possible in most of the patients. GPi stimulation has indications and
effects similar to those of pallidectomy: abnormal involuntary movements are
totally suppressed, whereas effects on akinesia and rigidity are not so
important as they are with STN stimulation. For all three targets, morbidity is
low and reversible, even when bilateral implantations are performed. The
deep-brain stimulation method has now proved its safety as compared with
ablative surgery and is able to provide a significant improvement to these
severely disabled patients. Long-term follow up is establishing the security of
the method, which should be considered in earlier stages of the disease actively
to participate to rehabilitation.
DOI: 10.1002/mds.870131321
PMID: 9827607 [Indexed for MEDLINE]