Lesioning and stimulation in tremor-predominant movement disorder patients: an institutional case series and patient-reported outcome.

Stereotact Funct Neurosurg 2012 5;90(3):181-7. Epub 2012 Jun 5.

Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, USA.

Background: In certain movement disorder cases, a combined stimulation and lesioning approach in the same patient could be the ideal beneficial option.

Objectives: The object of this study was to retrospectively examine the indications, outcome and complications in patients who had undergone both a lesioning (thalamotomy) and deep brain stimulation (DBS) procedure (bilateral or unilateral) for a tremor-predominant movement disorder performed by a single surgeon at one institution over a 15-year period.

Methods: A retrospective review of patient records was undertaken. Patient outcome was based on follow-up visit chart notes and on a non-validated patient telephone questionnaire.

Results: Thirty patients required a combined stimulation and lesioning approach to control tremor. Twelve patients had either unilateral or bilateral DBS as the first procedure followed by thalamotomy; two patients required a third procedure. Eighteen patients had thalamotomy as the first procedure followed by contralateral DBS either as the second or the third procedure. Eight patients required three procedures, which included either a repeat thalamotomy or a repeat DBS. We were able to contact 22 of 30 (15 male and 15 female, average age 70.7 ± 15.4 years) tremor-predominant movement disorder patients, retrospectively. Patient-reported outcome as assessed by a non-validated telephone questionnaire was: improvement in both symptoms and function in 59%, symptom but not function improvement in 32% and no improvement in either symptom or function or worsening in 9%. In comparison, based on retrospective chart review, 77% of patients had improved symptoms and functions, 20% of patients had improved symptoms with no effect on function and 3% of patients had no improvements of symptoms or functions.

Conclusions: Lesioning, which has to a great extent fallen out of favor, still has a valuable role to play in the treatment of tremor-predominant movement disorders; it can still be applied in combination with stimulation with outcome results similar to that of bilateral stimulation.

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http://dx.doi.org/10.1159/000338710DOI Listing
November 2012
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