What is the efficacy of thalamic deep brain stimulation (DBS) in the treatment of Parkinson disease (PD)?

Updated: Dec 09, 2020
  • Author: Konstantin V Slavin, MD; Chief Editor: Brian H Kopell, MD  more...
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Answer

The multicenter European study of thalamic stimulation in parkinsonian and essential tremor reported rates of significant improvement of 85% for Parkinson disease (PD) tremor and 89% for essential tremor (ET) at 12 months. [22] In most patients, the very good results with stimulation seen at 1 year were maintained after more than 6 years. [23]

Like thalamotomy, thalamic deep brain stimulation (DBS) often does not provide significant functional improvement for patients with PD, because their rest tremor is not usually a source of functional disability. In fact, nowadays, thalamic DBS is rarely—if ever—offered to patients with PD.

Thalamic DBS initially was used contralateral to previous thalamotomies to reduce the risk associated with bilateral thalamotomy. However, the results were so encouraging that thalamic DBS has become not only an accepted alternative to thalamotomy, but it is currently the procedure of choice for patients who require unilateral or bilateral procedures for medically refractory tremor. A decade of experience in Europe and the United States indicates that thalamic DBS is equivalent to thalamotomy for tremor suppression.

Because the lesion is eliminated, hemorrhage rates and cognitive adverse effects may prove less frequent than with thalamotomy. Side effects related to stimulation, including paresthesia, dysarthria, and gait disorders, are relatively common though reversible by setting adjustments. Device-related complications, including end of battery life, skin erosion, or infection can be observed and resolved in most cases.

The promising results initially achieved in the thalamus prompted the application of DBS to other key targets for the treatment of PD.

Thalamic stimulation involves implantation of a DBS lead in the ventral intermediate (VIM) nucleus of the thalamus. It provides significant control of Parkinson disease tremor but does not affect the other symptoms of Parkinson disease such as rigidity, bradykinesia, dyskinesia, or motor fluctuations.

Studies of thalamic DBS have demonstrated good initial and long-term tremor control up to 7 years after implantation; however, long-term studies have shown a significant worsening in other parkinsonian symptoms such as bradykinesia and rigidity and worsening of gait leading to major disability.

Candidates for thalamic DBS are patients with disabling medication-resistant tremor who have minimal rigidity or bradykinesia. They should not have significant cognitive impairment, mood or behavioral disturbances, or other factors that may increase the risk of surgery.


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