Long-Term Suppression of Extrapyramidal Motor Symptoms with Deep Brain Stimulation (DBS)

Abstract

Deep Brain Stimulation (DBS) was investigated for the treatment of extrapyramidal motor symptoms. Both tremor and rigidity as well as akinesia are known to be permanently suppressed by applying a high-frequency current to different basal ganglia nuclei.
Chronic DBS was performed in 113 patients using stereotactically implanted quadripolar electrodes in the ventrolateral thalamus (n = 43), the globus pallidus internus (n = 15), or the subthalamic nucleus (n = 55). Subcutaneous implantation of the generator occurred during a second procedure following correct positioning of the electrodes and confirmation of effectiveness by external stimulation. Patients were followed up using standardized rating scales before and after surgery.
Deep Brain Stimulation significantly suppresses extrapyramidal symptoms such as tremor (p < 0.001), rigidity (p < 0.001), dyskinesia (p < 0.01), akinesia, and dystonia (p < 0.05). Permanent side effects were avoided by changing the stimulation parameters. Severe complications occurred in only two patients (n = 2, 1.8 %). DBS is a safe and effective long-term treatment for tremor, rigidity, dyskinesia, akinesia and dystonia.

Zusammenfassung

Die Wertigkeit der tiefen Hirnstimulation wurde als Verfahren für die Langzeitbehandlung extrapyramidal-motorischer Symptome untersucht. Sowohl Tremor als auch Rigor können durch einen hochfrequenten kontinuierlichen elektrischen Impuls in den Basalganglienkernen unterdrückt werden.
Eine chronische tiefe Hirnstimulation wurde bei 113 Patienten unter Verwendung stereotaktisch implantierter quadripolarer Elektroden durchgeführt mit Zielpunkten im ventrolateralen Thalamus (n = 43), im Globus pallidus internus (n = 15) und im Nucleus subthalamicus (n = 55). Die subkutane Implantation der Stimulatoren erfolgte in einem zweiten Eingriff in Allgemeinanästhesie nach Bestätigung der exakten Lage der Elektroden und externer Stimulation. Die Patienten wurden prä- und postoperativ mit standardisierten Skalen untersucht und evaluiert.
Die tiefe Hirnstimulation führt zu einer signifikanten Unterdrückung extrapyramidaler Symptome wie Tremor (p < 0,001), Rigor (p < 0,001), Dyskinesien (p < 0,001), Akinese und Dystonie (p < 0,05). Dauerhafte Nebenwirkungen können durch Veränderung der Stimulationsparameter vermieden werden. Schwere Komplikationen traten bei 2 Patienten (1,8 %) auf.
Die kontinuierliche tiefe hochfrequente Hirnstimulation stellt ein sicheres Verfahren für die Behandlung von Tremor, Rigor, Akinese, Dyskinesie und Dystonie dar.

Key words

Deep Brain Stimulation - Parkinson's disease - tremor - stereotactic surgery - dystonia

Schlüsselwörter

Tiefe Hirnstimulation - Morbus Parkinson - Tremor - Stereotaxie - Dystonie

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