Beckers, M. (Milan) (2012) Diepe hersenstimulatie en (sub)thalamotomie bij tremoren: een retrospectieve vergelijking van de verschillende targets. thesis, Medicine.
Full text available on request.Abstract
Background: Several targets are used for deep brain stimulation (DBS) and (sub)thalamotomy for tremors: the ventral intermediate nucleus of the thalamus (Vim), the subthalamic nucleus (STN), the internal globus pallidus (GPI) and the relatively new zona incerta (ZI). This retrospective analysis compared the targets, with special focus on the ZI. Methods: In telephone interviews, 68 tremor patients, treated neurosurgically between 1994 and 2011, were asked about efficacy, with the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) scale as the primary outcome measure for essential tremor (ET), Holmes’ tremor (HT), and multiple sclerosis (MS) and item 16 of the Unified Parkinson’s Disease Rating Scale (UPDRS) for Parkinson’s disease (PD). Adverse effects and tolerance were defined and scored using a questionnaire. Results: Mean WHIGET reduction in ET-DBS was 1.73 +/-1.24 (47.4%) from baseline (p=0.000). Per target: STN 2.00 +/- 0 (50%), Vim 1.60 +/-1.35 (42.1%), ZI 1.78 +/-1.28 (50%), without a sig. difference between targets (p=0.888). Mean UPDRS-16 reduction in PD-DBS was 2.19 +/- 1.66 (71.7%) (p=0.000). Per target: STN 2.43 +/- 1.71 (80%), GPI 1.15 +/- 1.67 (51.1%), Vim 2.40 +/- 1.52 (60%), ZI 2.00 +/- 0 (52.6%); there wasa sig. difference between STN and GPI (p=0.031). In PD-DBS, sensory adverse effects were more frequent in Vim (p=0.0093) and GPI (p=0.0329). Tolerance occurred in 32,3% of all DBS cases. Per target: STN 17.9%, GPI 12.5%, Vim 80%, ZI 41.7%; a sig. difference between STN vs. other (p=0.017) was demonstrated. Conclusions 1. DBS suppresses tremor by 47,4% in ET and 71,7% in PD. 2. Choice of target has no influence in ET; in PD, STN causes greater tremor reduction than GPI. 3. In PD, more sensory adverse effects are seen in Vim and GPI than in other DBS targets; 4. Comparing the DBS targets, a greater occurrence of tolerance was seen in STN than in other targets.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleider: and Laar, dr. T. van and Neurologie, UMC Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:59 |
| Last Modified: | 25 Jun 2020 10:59 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1957 |
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