Using Directional Deep Brain Stimulation to Co-activate the Subthalamic Nucleus and Zona Incerta for Overlapping Essential Tremor/Parkinson's Disease Symptoms

Frontiers in Neurology
Ramsey A FalconerMahesh Shenai

Abstract

This index case report describes a novel programming approach that utilizes the 8-contact directional Deep Brain Stimulation (DBS) lead to effectively control the akinesia, rigidity and tremor of Parkinson's Disease (PD), as well as a severe kinetic tremor of Essential Tremor (ET), in a patient with overlapping symptoms of both PD and ET. Through utilizing a bipolar directional montage on a single segmented contact, symptom control was attained via likely co-activation of the Subthalamic Nucleus (STN) and the adjacent Zona Incerta (ZI). The patient is a 67-year-old professional guitarist with a long-standing diagnosis of ET manifesting with bilateral kinetic tremor, who then developed right lateralizing symptoms indicative of PD. After optimal medical management did not confer sufficient control, he underwent left-sided unilateral DBS targeting the STN. Both intraoperatively and post-operatively, omnidirectional, and directional electrode review resulted in significant akinesia, rigidity, and as well as resting tremor control but failed to sufficiently improve the kinetic tremor. As electrode 2B was shown to be the most efficacious with the largest therapeutic window, a bipolar directional montage on a single segmented contact ...Continue Reading

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Citations

Jun 18, 2019·Advanced Materials·Nikita ObidinCanan Dagdeviren
May 16, 2020·Frontiers in Human Neuroscience·Ilknur TelkesJulie G Pilitsis
Aug 11, 2020·Tremor and Other Hyperkinetic Movements·Anant WadhwaAmar Patel
Feb 15, 2021·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Islam FayedChristopher G Kalhorn
Jul 31, 2021·Expert Review of Medical Devices·Bhavana PatelAdolfo Ramirez-Zamora

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