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Cited by 252Neurological disorders and treatmentsObsessive-Compulsive Spectrum DisordersParkinson's Disease Mechanisms and Treatments

Treatment of tremor in Parkinson’s disease by subthalamic nucleus stimulation

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Krack, P., Benazzouz, Abdelhamid, Pollak, Pierre, Limousin, Patricia, Piallat, Brigitte, Hoffmann, Dominique, Xie, Jing, Benabid, Alim‐Louis·1998·Movement Disorders
DOI 10.1002/mds.870130608
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Abstract

The recent resurgent interest in functional surgery for the treatment of Parkinson's disease (PD) has focused on the effects on akinesia and levodopa‐induced dyskinesia. Stimulation of the subthalamic nucleus (STN) improves akinesia and rigidity but its effects on tremor have not been studied. The objective of this study was to assess the efficacy of STN stimulation on tremor in patients with the complete parkinsonian triad with motor fluctuations. Of 27 consecutive patients with STN stimulation (26 bilateral), 15 exhibited tremor rated at least 2/4 according to item 20 (rest tremor) of the Unified Parkinson's Disease Rating Scale (UPDRS) in at least one limb. The mean preoperative tremor score was 11.3 ± 5.6 in off‐drug and 1.2 ± 2.4 in on‐drug conditions. The postoperative tremor scores at the last follow up (from 1–12 months) were 2.2 ± 2.2 off‐drug/on‐stimulation and 0.2 ± 0.4 on‐drug/on‐stimulation. Both rest and action tremors were improved in all patients. The UPDRS tremor score was reduced by 80%, rigidity score by 65%, and akinesia score by 51% on average. For the three symptoms, the stimulation effect was close to that induced before surgery by a suprathreshold dose of levodopa given in the morning. STN stimulation can be considered an interesting alternative to thalamic or internal pallidal surgery even in PD patients with severe high‐amplitude tremor. In keeping with electrophysiological data in monkeys rendered parkinsonian by MPTP injections, our results emphasize the importance of the oscillation of a neuronal loop involving the STN in the pathophysiology of parkinsonian tremor.

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  • Tremor suppression by high frequency stimulation or lesioning at these sites need not necessarily imply interference with a pacemaker circuit, and could potentially arise from interference with the pacemaker circuit's outflow or mechanisms amplifying this outflow.

    “The fact that tremor may be suppressed by high frequency stimulation, or indeed lesioning, at these sites (Benabid et al., 1991; Lenz et al., 1995; Krack et al., 1998; Fasano et al., 2012) need not necessarily imply interference with a pacemaker circuit, and could potentially arise from interference with the pacemaker circuit’s outflow or mechanisms amplifying this outflow.”

    From The nature of tremor circuits in parkinsonian and essential tremor (2014) · cites this paper as Krack et al., 1998

  • The clinical effects of high frequency stimulation of the subthalamic nucleus and ventrolateral thalamus on parkinsonian tremor suggest that the two sites are essential components of the tremor circuit.

    “The clinical effects of high frequency stimulation of the two targets on parkinsonian tremor would further suggest that the two sites are essential components of the tremor circuit (Benabid et al., 1991; Krack et al., 1998).”

    From The nature of tremor circuits in parkinsonian and essential tremor (2014) · cites this paper as Krack et al., 1998

  • High frequency stimulation of the subthalamic nucleus may be as effective as high frequency stimulation of the ventrolateral thalamus in suppressing Parkinson's disease tremor.

    “complements the clinical observation that high frequency stimulation of the subthalamic nucleus may be as effective as high frequency stimulation of the ventrolateral thalamus in suppressing Parkinson’s disease tremor (Krack et al., 1998)”

    From The nature of tremor circuits in parkinsonian and essential tremor (2014) · cites this paper as Krack et al., 1998

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Authors
Krack, P., Benazzouz, A., Pollak, P., Limousin, P., Piallat, B., Hoffmann, D., Xie, J., & Benabid, A.
Affiliations
Centre Hospitalier Universitaire de Grenoble (FR)
Corresponding author
Krack, P.
ORCID
Venue
Movement Disorders
Publisher
Wiley
Published
1998-11
Volume
13
Issue
6
Pages
907-914
ISSN
  • 0885-3185 (ISSN-L)
  • 1531-8257
DOI
10.1002/mds.870130608
OpenAlex
W2052211978
Cited by
252
References
48
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 7 · 2022: 3 · 2021: 4 · 2019: 5 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 3 · 2014: 6 · 2013: 8 · 2012: 9
FWCI
11.86
Type
journal article
Language
en
Open access
Licence
Locations
  • Movement Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
Keywords
Parkinson's disease, tremor, subthalamic nucleus, deep brain stimulation, resting tremor, action tremor, akinesia, rigidity, motor fluctuations, levodopa, thalamic stimulation, pallidal stimulation, neural oscillations, MPTP
MeSH terms
Adult, Aged, Electrodes, Implanted, Electrophysiology, Electric Stimulation Therapy, Female, Humans, Male, Middle Aged, Parkinson Disease, Stereotaxic Techniques, Thalamic Nuclei, Tremor, Statistics, Nonparametric

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