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Long‐term follow‐up of thalamic stimulation versus thalamotomy for tremor suppression
Author(s) -
Schuurman P. Richard,
Bosch D. Andries,
Merkus Maruschka P.,
Speelman Johannes D.
Publication year - 2008
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.22059
Subject(s) - thalamotomy , thalamic stimulator , essential tremor , deep brain stimulation , medicine , stimulation , parkinson's disease , multiple sclerosis , intention tremor , neurological disorder , anesthesia , physical medicine and rehabilitation , central nervous system disease , physical therapy , psychology , surgery , disease , psychiatry , ataxia
Thalamic stimulation and thalamotomy for treatment of tremor due to Parkinson's disease, essential tremor, and multiple sclerosis were compared in a randomized trial. The symptomatic and functional outcome was studied after 5 years of follow‐up. Sixty‐eight patients were treated (45 Parkinson's disease, 13 essential tremor, 10 multiple sclerosis) by thalamotomy (n = 34) or thalamic stimulation (n = 34). After 5 years, 48 patients were available for follow‐up. The primary outcome measure was change in functional status measured by the Frenchay Activities Index (FAI), scores ranging from 0 to 60. Secondary outcome measures were tremor severity, frequency of complications, and patients' assessment of the outcome. The mean difference in FAI scores between thalamic stimulation and thalamotomy was 4.4 (95% CI: 1.1–7.7) after 6 months, 3.3 (95% CI: −0.03–6.6) after 2 years and 4.0 (95% CI: 0.3–7.7) after 5 years in favor of stimulation. Tremor suppression was equally effective after both procedures, and stable in Parkinson patients. In ET and multiple sclerosis, a diminished effect of stimulation was observed in half of the patients. There were six stimulation equipment‐related complications, but neurological side effects of surgery were higher after thalamotomy. Subjective outcome‐assessment by the patients was more favorable in the stimulation group. © 2008 Movement Disorder Society.