Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic Area
Background: Deep brain stimulation of the motor thalamus or the posterior subthalamic area (PSA) shows promising results for patients with voice tremor, although only for about 50% of patients. There are indications that voice tremor requires more focused stimulation within the target area compared...
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doaj-2d088e34cbde49369d61a105377806262020-11-25T00:21:02ZengElsevierWorld Neurosurgery: X2590-13972019-07-013Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic AreaLinda Sandström0Patric Blomstedt1Fredrik Karlsson2Department of Clinical Science, Umeå University, Umeå, Sweden; To whom correspondence should be addressed: Linda Sandström, Ph.D. CandidateDepartment of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, SwedenDepartment of Clinical Science, Umeå University, Umeå, SwedenBackground: Deep brain stimulation of the motor thalamus or the posterior subthalamic area (PSA) shows promising results for patients with voice tremor, although only for about 50% of patients. There are indications that voice tremor requires more focused stimulation within the target area compared with hand tremor. The objective of the present study was to determine the most efficient location for reducing voice tremor within the PSA. Methods: Thirty-seven patients with essential tremor were evaluated off stimulation and in a set of experimental conditions with unilateral stimulation at increasing amplitude levels. Two listeners performed blinded assessments of voice tremor from recordings of sustained vowel productions. Results: Twenty-five patients (68%) had voice tremor. Unilateral stimulation reduced voice tremor for the majority of patients, and only 6 patients had poor outcomes. Contacts yielding efficient voice tremor reduction were deeper relative to the midcommissural point (MCP) and more posterior relative to the posterior tip of the subthalamic nucleus (pSTN) (zMCP = –3.1, ypSTN = –0.2) compared with poor contacts (zMCP = –0.7, ypSTN = 1.0). High-amplitude stimulation worsened voice tremor for 7 patients and induced voice tremor in 2 patients. Hand tremor improved to a greater extent than voice tremor, and improvements could be seen throughout the target area. Conclusions: Our results indicate that efficient voice tremor reduction can be achieved by stimulating contacts located in the inferior part of the PSA, close or slightly posterior to the pSTN. We observed cases in which voice tremor was induced by high-amplitude stimulation. Key words: Caudal zona incerta, Deep brain stimulation, Electrode location, Essential tremor, Posterior subthalamic area, Voice tremorhttp://www.sciencedirect.com/science/article/pii/S2590139719300559 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Linda Sandström Patric Blomstedt Fredrik Karlsson |
spellingShingle |
Linda Sandström Patric Blomstedt Fredrik Karlsson Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic Area World Neurosurgery: X |
author_facet |
Linda Sandström Patric Blomstedt Fredrik Karlsson |
author_sort |
Linda Sandström |
title |
Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic Area |
title_short |
Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic Area |
title_full |
Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic Area |
title_fullStr |
Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic Area |
title_full_unstemmed |
Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic Area |
title_sort |
voice tremor response to deep brain stimulation in relation to electrode location in the posterior subthalamic area |
publisher |
Elsevier |
series |
World Neurosurgery: X |
issn |
2590-1397 |
publishDate |
2019-07-01 |
description |
Background: Deep brain stimulation of the motor thalamus or the posterior subthalamic area (PSA) shows promising results for patients with voice tremor, although only for about 50% of patients. There are indications that voice tremor requires more focused stimulation within the target area compared with hand tremor. The objective of the present study was to determine the most efficient location for reducing voice tremor within the PSA. Methods: Thirty-seven patients with essential tremor were evaluated off stimulation and in a set of experimental conditions with unilateral stimulation at increasing amplitude levels. Two listeners performed blinded assessments of voice tremor from recordings of sustained vowel productions. Results: Twenty-five patients (68%) had voice tremor. Unilateral stimulation reduced voice tremor for the majority of patients, and only 6 patients had poor outcomes. Contacts yielding efficient voice tremor reduction were deeper relative to the midcommissural point (MCP) and more posterior relative to the posterior tip of the subthalamic nucleus (pSTN) (zMCP = –3.1, ypSTN = –0.2) compared with poor contacts (zMCP = –0.7, ypSTN = 1.0). High-amplitude stimulation worsened voice tremor for 7 patients and induced voice tremor in 2 patients. Hand tremor improved to a greater extent than voice tremor, and improvements could be seen throughout the target area. Conclusions: Our results indicate that efficient voice tremor reduction can be achieved by stimulating contacts located in the inferior part of the PSA, close or slightly posterior to the pSTN. We observed cases in which voice tremor was induced by high-amplitude stimulation. Key words: Caudal zona incerta, Deep brain stimulation, Electrode location, Essential tremor, Posterior subthalamic area, Voice tremor |
url |
http://www.sciencedirect.com/science/article/pii/S2590139719300559 |
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