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  • Title: Thalamotomy as a treatment option for tremor after ineffective deep brain stimulation.
    Author: Bahgat D, Magill ST, Berk C, McCartney S, Burchiel KJ.
    Journal: Stereotact Funct Neurosurg; 2013; 91(1):18-23. PubMed ID: 23154796.
    Abstract:
    BACKGROUND: As the number of deep brain stimulation (DBS) surgeries increases, complications from malpositioned electrodes, tolerance to stimulation and loss of efficacy have also increased. Our objective was to assess thalamotomy as a salvage treatment option after ineffective DBS. METHODS: A retrospective chart analysis of patients who underwent ipsilateral stereotactic thalamotomy after an ineffective ventrointermediate nucleus DBS procedure was undertaken. Patient outcome was based on follow-up visit chart notes, and a nonvalidated patient telephone questionnaire to assess patients' perception of tremor and functional ability after thalamotomy. RESULTS: Six patients with essential tremor and 1 with tremor-predominant Parkinson's disease met our inclusion criteria. Thalamotomies were undertaken for ineffective DBS due to dysarthria and paresthesias with programming in 2 patients, tremor that failed to respond to increased DBS despite a lack of side effects in 2 patients, malpositioned electrode in 2 patients, and sudden loss of DBS efficacy following eye surgery in 1 patient. Following thalamotomy, 3 patients reported improvement in symptoms and function, 3 patients reported improvement in symptoms that were not reflected in functional improvement, and 1 patient reported no improvement in symptoms or function. CONCLUSION: Thalamotomy may provide a viable salvage solution in patients who fail to respond to DBS due to complications such as malpositioned electrodes, tolerance to stimulation or loss of efficacy.
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