Brain Atrophy Following Deep Brain Stimulation: Management of a Moving Target. (21st October 2020)

• Record Type: Journal Article
• Authors: Chiu, Shannon Y.; Deeb, Wissam; Zeilman, Pamela; Ramirez-Zamora, Adolfo; Patterson, Addie; Patel, Bhavana; Foote, Kelly D.; Okun, Michael S.; Patel, Amar; Almeida, Leonardo
• Is Part Of: Tremor and other hyperkinetic movements. Volume 10(2020)
• Publication Date: 2020-10-21
• Subjects: deep brain stimulation (DBS) -- ventralis intermedius nucleus (VIM) -- essential tremor (ET) -- lead shift -- brain atrophy; Tremor -- Periodicals; Hyperkinesia -- Periodicals; 616.8
• DOI: 10.5334/tohm.546
• Languages: English
• ISSNs: 2160-8288

Abstract

Clinical vignette: A 51-year-old man with essential tremor (ET) had bilateral ventralis intermedius nucleus deep brain stimulation (VIM-DBS) placed to address refractory tremor. Despite well-placed DBS leads and adequate tremor response, he subsequently experienced worsening. Re-programming of the device and reconfirming the electrical thresholds for benefits and side effects were both performed. Six years following DBS implantation, repeat imaging revealed brain atrophy and a measured lead position change with a coincident change in clinical response. Clinical dilemma: What do we know about brain atrophy affecting lead placement and long-term DBS effectiveness? What are the potential strategies to combat narrowed therapeutic thresholds and to maximize DBS therapeutic benefit? Clinical solution: Decreasing the electrical field of stimulation and programming in a bipolar configuration are strategies to provide symptomatic tremor control and to minimize stimulation-induced side effects. Gaps in knowledge: Currently, effects of brain atrophy, and factors underpinning emergence of side effects and/or loss of benefit in chronic VIM-DBS remain largely unexplored.