Abstract Details

Title Outcomes with VIM deep brain stimulation in dystonic tremor versus essential tremor

Topic Movement Disorders

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-045

Objective Compare the effects of ventral intermediate nucleus (VIM) deep brain stimulation (DBS) in dystonic tremor (DT) versus essential tremor (ET).

Background DT is frequently misdiagnosed as ET and treatment approaches frequently overlap despite a distinct pathophysiology underlying these disorders. VIM DBS is a proven treatment for select cases of ET however there is scant literature on the effectiveness of DBS in DT. Only few case series have detailed outcomes of VIM DBS in DT and a systematic comparison of outcomes in DT versus ET is clearly lacking.

Design/Methods 23 DT patients and 43 ET patients who underwent unilateral or bilateral VIM DBS were retrospectively analyzed. Tremor outcome was longitudinally monitored with the Fahn-Tolosa-Marin tremor rating scale at six months, 1 year, 2–3 years, 4–5 years, and last follow-up when compared to baseline preoperative scores. DBS outcome for each group was analyzed with the Wilcoxon signed-rank test and between-group comparison of change in scores in DT versus ET was performed with Mann–Whitney U test.

Results Compared to baseline, the total, activities of daily living (ADL), and motor scores in DT significantly improved at six months and 1 year only (p < 0.001), however the contralateral composite arm tremor score (rest, postural, and kinetic) remained significantly improved up to 5 years after surgery. Improvement in arm tremor was not significantly different between DT and ET patients at each follow-up visit (p > 0.05). While there was no difference in the total and the motor scores between DT and ET throughout the follow-up, ADL improvements were significantly less in the DT group.

Conclusions VIM DBS effectively controls arm tremor in DT. DBS benefits in DT are similar to ET but differ in patient-reported ADL scores, possibly due to insufficient control of concomitant dystonia symptoms. Clinical improvement only slightly favoring ET matches our bedside observations.

Authors/Disclosures
Takashi Tsuboi, PhD (Nagoya University) PRESENTER	No disclosure on file
Zakia Jabarkheel (University of Florida Department of Neurology)	No disclosure on file
Kelly D. Foote, MD	Kelly D. Foote, MD has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Axio/Neurocrine Biosciences.
Michael S. Okun, MD, FAAN (University of Florida)	Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.
Aparna Wagle-Shukla, MD, FAAN (UF Fixel)	Dr. Wagle-Shukla has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Encora. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Supernus. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Tremor research group. The institution of Dr. Wagle-Shukla has received research support from NIH. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving as a reviewer with NIH.

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