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Master Thesis

Traitement du tremblement dystonique par stimulation cérébrale profonde combinée du noyau ventral intermédiaire du thalamus et du globus pallidus interne

Abstract : Context : dystonic Tremor (DT) is defined as tremor in a body part affected by dystonia. Deep brain stimulation (DBS) is indicated for disabling and medically-refractory DT, but optimal DBS target remains unknown. Case studies have shown better outcomes for DT after a second target was added, resulting in a combined DBS of the ventral intermediate nucleus of the thalamus (VIM), and the internal globus pallidus (GPi). This study aimed to evaluate the effect and safety of combined and bilateral VIM and GPi DBS at one year or more post-implantation for disabling and medically-refractory upper limb (UL) DT.
Methods : this single-blind observational study investigates outcomes for three patients who underwent combined and bilateral VIM-GPi-DBS surgery a year ago or more, to treat disabling and medically-refractory upper-limb DT. During a routine clinical follow-up, the Fahn-Tolosa-Marin-tremor-rating-scale (FTMTRS) and Burke-Fahn-Marsden-dystonia-rating-scale (BFMDRS) were used to evaluate severity of the dystonic tremor (blinded video examinations by experts), and activities of daily living (self-reported by the patients) in four situations of DBS: DBS-OFF, VIM-DBS, GPi-DBS and VIM-GPi-DBS. Adverse events related to surgery and hardware, side effects of the DBS, and cognitive decline were investigated.
Results : the FTMTRS for UL showed 51% improvement with combined VIM-GPi-DBS, 31% with GPi-DBS, 28% with VIM-DBS, compared to DBS-OFF. Similar results were observed with the BFMDRS for upper limbs, and FTMTRS and BFMDS movement, disability, and total scores. This supports the hypothesis of a DT pathophysiology affecting two separate networks: cerebello-thalamo-cortical and, basal ganglia-thalamo-cortical. The only side effect related to DBS was continuous lingual paresthesias for a patient during VIM-DBS. No cognitive decline or adverse event concerning the surgery or hardware was observed.
Conclusion : our study suggests better outcomes for dystonic tremor with combined VIM-GPi-DBS compared to single-target DBS, without serious AE at one year or more post-surgery. This treatment can be considered for patients presenting with disabling and medically-refractory DT. Further studies would be useful to confirm these results and precise DBS effects on each target VIM and GPi.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03625318
Contributor : Bibliothèque Universitaire de Médecine Nice Connect in order to contact the contributor
Submitted on : Wednesday, March 30, 2022 - 5:57:07 PM
Last modification on : Saturday, April 2, 2022 - 3:15:44 AM

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2021NICEM117.pdf
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  • HAL Id : dumas-03625318, version 1

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Caroline Trompette. Traitement du tremblement dystonique par stimulation cérébrale profonde combinée du noyau ventral intermédiaire du thalamus et du globus pallidus interne. Médecine humaine et pathologie. 2021. ⟨dumas-03625318⟩

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