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Treatment of tremor in Parkinson’s disease by subthalamic nucleus stimulation
Open accessAbstract
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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“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
In the citing paper
“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
In the citing paper
“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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“…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), although tremor suppression need not necessarily demonstrate interference with a pacemaker circuit, and could potentially…”
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Metadata
- 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.
- Venue
- Movement Disorders
- Publisher
- Wiley
- Published
- 1998-11
- Volume
- 13
- Issue
- 6
- Pages
- 907-914
- ISSN
- 0885-3185 (ISSN-L)
- 1531-8257
- 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
- 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 › Clinical Neurology › Deep Brain Stimulation and Movement Disorders
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Clinical 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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