Treatment of tremor in Parkinson’s disease by subthalamic nucleus stimulation

P. Krack, Abdelhamid Benazzouz, Pierre Pollak, Patricia Limousin, Brigitte Piallat, Dominique Hoffmann, Jing Xie, Alim‐Louis Benabid
Mov. Disord.. 1998-11-01; 13(6): 907-914
DOI: 10.1002/mds.870130608

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1. Mov Disord. 1998 Nov;13(6):907-14. doi: 10.1002/mds.870130608.

Treatment of tremor in Parkinson’s disease by subthalamic nucleus stimulation.

Krack P(1), Benazzouz A, Pollak P, Limousin P, Piallat B, Hoffmann D, Xie J,
Benabid AL.

Author information:
(1)Department of Clinical and Biological Neurosciences, Centre Hospitalier
Universitaire, Grenoble, France.

The recent resurgent interest in functional surgery for the treatment of
Parkinson’s disease (PD) has focused on the effects on akinesia and
levodopa-induced dyskinesia. Stimulation of the subthalamic nucleus (STN)
improves akinesia and rigidity but its effects on tremor have not been studied.
The objective of this study was to assess the efficacy of STN stimulation on
tremor in patients with the complete parkinsonian triad with motor fluctuations.
Of 27 consecutive patients with STN stimulation (26 bilateral), 15 exhibited
tremor rated at least 2/4 according to item 20 (rest tremor) of the Unified
Parkinson’s Disease Rating Scale (UPDRS) in at least one limb. The mean
preoperative tremor score was 11.3+/-5.6 in off-drug and 1.2+/-2.4 in on-drug
conditions. The postoperative tremor scores at the last follow up (from 1-12
months) were 2.2+/-2.2 off-drug/on-stimulation and 0.2+/-0.4
on-drug/on-stimulation. Both rest and action tremors were improved in all
patients. The UPDRS tremor score was reduced by 80%, rigidity score by 65%, and
akinesia score by 51% on average. For the three symptoms, the stimulation effect
was close to that induced before surgery by a suprathreshold dose of levodopa
given in the morning. STN stimulation can be considered an interesting
alternative to thalamic or internal pallidal surgery even in PD patients with
severe high-amplitude tremor. In keeping with electrophysiological data in
monkeys rendered parkinsonian by MPTP injections, our results emphasize the
importance of the oscillation of a neuronal loop involving the STN in the
pathophysiology of parkinsonian tremor.

DOI: 10.1002/mds.870130608
PMID: 9827614 [Indexed for MEDLINE]

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