Premium
Postoperative management of Vim DBS for tremor
Author(s) -
DowseyLimousin Patricia
Publication year - 2002
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.10165
Subject(s) - dysarthria , essential tremor , medicine , stimulation , implant , lesion , deep brain stimulation , physical medicine and rehabilitation , electromyography , parkinson's disease , psychology , anesthesia , audiology , surgery , disease
Stimulation of the ventralis intermedius (Vim) is a treatment of severe tremor from various origins. The adjustment of electrical parameters is done when the lesion‐like effects of the implant disappear. Each contact is assessed successively, by using a constant pulse width of 60 μsec and a frequency of 130 Hz or above and progressively increasing the voltage. At the same time, the tremor and possible side effects are monitored. The most frequent side effects are paresthesias, dysarthria, muscle contractions related to stimulation of the pyramidal tract, and cerebellar syndrome. Medications have to be adjusted slowly, and often, particularly in case of Parkinson's disease, it is difficult to decrease the dosage. It is important to teach the patient to switch the stimulator on or off and check that it is working. Patients need to be seen within the 3 months after implant, then occasionally according to the effect. In the long‐term, some patients will develop some rebound of tremor when they switch off and/or some tolerance to the effect of the stimulator, which can be difficult to manage. In case of Parkinson's disease, motor fluctuations and dyskinesias, that does not respond to Vim stimulation, can occur. © 2002 Movement Disorder Society