Lesioning and stimulation in tremor-predominant movement disorder patients

An institutional case series and patient-reported outcome

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)181-187
Number of pages7
JournalStereotactic and Functional Neurosurgery
Volume90
Issue number3
DOIs
StatePublished - Jun 2012

Fingerprint

Movement Disorders
Tremor
Deep Brain Stimulation
Patient Reported Outcome Measures
Telephone

Keywords

  • Deep brain stimulation
  • Lesioning
  • Movement disorder
  • Outcome
  • Tremor

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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title = "Lesioning and stimulation in tremor-predominant movement disorder patients: An institutional case series and patient-reported outcome",
abstract = "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.",
keywords = "Deep brain stimulation, Lesioning, Movement disorder, Outcome, Tremor",
author = "Diaa Bahgat and Ahmed Raslan and Shirley McCartney and Kim Burchiel",
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pages = "181--187",
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T1 - Lesioning and stimulation in tremor-predominant movement disorder patients

T2 - An institutional case series and patient-reported outcome

AU - Bahgat, Diaa

AU - Raslan, Ahmed

AU - McCartney, Shirley

AU - Burchiel, Kim

PY - 2012/6

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N2 - 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.

AB - 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.

KW - Deep brain stimulation

KW - Lesioning

KW - Movement disorder

KW - Outcome

KW - Tremor

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