Ventral Intermediate Nucleus Versus Zona Incerta Region Deep Brain Stimulation in Essential Tremor

Robert S. Eisinger, Joshua Wong, Leonardo Almeida, Adolfo Ramirez-Zamora, Jackson N. Cagle, Juan C. Giugni, Bilal Ahmed, Alberto R. Bona, Erin Monari, Aparna Wagle Shukla, Christopher W. Hess, Justin D. Hilliard, Kelly D. Foote, Aysegul Gunduz, Michael S. Okun, Daniel Martinez-Ramirez

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Background: The ventral intermediate nucleus (VIM) is the target of choice for Essential Tremor (ET) deep brain stimulation (DBS). Renewed interest in caudal zona incerta (cZI) stimulation for tremor control has recently emerged and some groups believe this approach may address long-term reduction of benefit seen with VIM-DBS. Objectives: To compare clinical outcomes and DBS programming in the long-term between VIM and cZI neurostimulation in ET-DBS patients. Materials and Methods: A retrospective review of 53 DBS leads from 47 patients was performed. Patients were classified into VIM or cZI groups according to the location of the activated DBS contact. Demographics, DBS settings, and Tremor Rating Scale scores were compared between groups at baseline and yearly follow-up to 4 years after DBS. Student t-tests and analysis of variance (ANOVA) were used to compare variables between groups. Results: Relative to baseline, an improvement in ON-DBS tremor scores was observed in both groups from 6 months to 4 years post-DBS (p < 0.05). Although improvement was still significant at 4 years, scores from month 6 to 2 years were comparable between groups but at 3 and 4 years post-DBS the outcome was better in the VIM group (p < 0.01). Stimulation settings were similar across groups, although we found a lower voltage in the VIM group at 3 years post-DBS. Conclusions: More ventral DBS contacts in the cZI region do improve tremor, however, VIM-DBS provided better long-term outcomes. Randomized controlled trials comparing cZI vs VIM targets should confirm these results.

Original languageEnglish
Pages (from-to)75-82
Number of pages8
JournalMovement Disorders Clinical Practice
Volume5
Issue number1
DOIs
StatePublished - Jan 1 2018

Bibliographical note

Funding Information:
Ethical Compliance Statement: We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. Funding Sources and Conflict of Interest: This work was supported by the National Parkinson Foundation (1UH3NS095553-01A1), Tyler’s Hope, Bachmann-Strauss Foundation, University of Florida Foundation, and the UF INFORM database. Financial disclosures from previous 12 months: RSE, JW, LA, ARZ, JNC, JG, BA, ARB, AWS, EM, and JDH have no financial disclosures to report. CWH receives grant support from the University of Florida Clinical and Translational Research Institute, which is supported in part by NIH award KL2 TR001429. He has served as a research committee member for the Michael J. Fox Foundation and as a speaker for the National Parkinson Foundation, the Parkinson’s Disease Foundation, and the Davis Phinney Foundation. CWH has participated in CME and educational activities on movement disorders sponsored by Allergan, Ipsen, Mertz Pharmaceuticals, Peerview Online, and QuantiaMD. DMR serves as a consultant for the National Parkinson Foundation and has received honoraria for educational activities from Teva, UCB, Boehringer-Ingelheim, and the International Parkinson and Movement Disorders Society. KDF has received research grant support from Medtronic, St. Jude (now Abbott), Boston Scientific, Neuropace, and Functional Neuromodulation. He has also received fellowship support from Medtronic. He has not received any personal renumeration from any industrial source in the past 12 months. AG receives grant support from the NIH and NSF. The University of Florida and not AG receives device donations from Medtronic, LLC. MSO serves as a consultant for the National Parkinson Foundation and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bach-mann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. MSO’s DBS research is supported by: R01 NR014852. MSO has previously received honoraria, but in the past > 60 months has received no support from industry. MSO has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, and Cambridge (movement disorders books). MSO is an associate editor for New England Journal of Medicine Journal Watch Neurology. MSO has participated in CME and educational activities on movement disorders (in the last 36) months sponsored by Peer-View, Prime, QuantiaMD, WebMD, MedNet, Henry Stewart, and by Vanderbilt University. The institution and not MSO receives grants from Medtronic, AbbVie, Allergan, and ANS/ St. Jude, and the Principal Investigator (PI) has no financial interest in these grants. MSO has participated as a site PI and/ or co-investigator for several NIH, foundation, and industry sponsored trials over the years, but has not received honoraria.

Funding Information:
We would like to acknowledge the support of the National Parkinson Foundation, Tyler's Hope, and the Bachmann-Strauss Foundations. Also we would like to acknowledge the UF Foundation and the UF INFORM database.

Funding Information:
We would like to acknowledge the support of the National Parkinson Foundation, Tyler’s Hope, and the Bachmann-Strauss Foundations. Also we would like to acknowledge the UF Foundation and the UF INFORM database.

Publisher Copyright:
© 2017 International Parkinson and Movement Disorder Society

Keywords

  • cerebellar pathways
  • intermediate nucleus
  • posterior subthalamic area
  • tremor
  • ventral zona incerta

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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