Double-target DBS for essential tremor: 8-contact lead for cZI and Vim aligned in the same trajectory
Citation Manager Formats
Make Comment
See Comments

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Essential tremor (ET) can be disabling and frequently affects a patient's quality of life. Although many patients will benefit from pharmacologic therapy, up to 50% of patients with ET can present unsatisfactory tremor control due to drug adverse effects, comorbidities, or suboptimal response. Those patients may need additional surgical treatment. Bilateral deep brain stimulation (DBS) of the thalamic Vim nucleus has been accepted as the standard treatment, but results are limited by side effects such as speech impairment, ataxia, and stimulation tolerance in the long term1; in extreme cases, reoperation may be required.2 More recently, stimulation of the posterior subthalamic area (PSA) that comprises the prelemniscal radiation and the caudal zona incerta (cZI)3 emerged as a promising target for tremor control with encouraging results. Technology has advanced, providing multiple contact electrodes that can increase possibilities for tremor control and perhaps minimize side effects. We propose bilateral implantation of 8-contact electrodes aligning the Vim and the cZI in the same trajectory, offering multiple stimulation targets with no additional risk. The index case of refractory ET treated with bilateral double-target DBS is presented here.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received September 19, 2017.
- Accepted in final form December 18, 2017.
- © 2018 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. Nicole Sur and Dr. Mausaminben Hathidara
► Watch
Related Articles
- No related articles found.
Topics Discussed
Alert Me
Recommended articles
-
Articles
Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulationR. Kumar, A.M. Lozano, E. Sime et al.Neurology, August 01, 1999 -
Article
Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremorTakashi Tsuboi, Zakia Jabarkheel, Pamela R. Zeilman et al.Neurology, February 11, 2020 -
Brief Communications
Bipolar deep brain stimulation permits routine EKG, EEG, and polysomnographyRobert C. Frysinger, Mark Quigg, W. Jeffrey Elias et al.Neurology, January 24, 2006 -
Expedited Publication
Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson's diseaseR. Kumar, A. M. Lozano, Y. J. Kim et al.Neurology, September 01, 1998