Loss of benefit in VIM thalamic deep brain stimulation (DBS) for essential tremor (ET): How prevalent is it?
Abstract
Ventralis intermedius (Vim) thalamic deep brain stimulation for medication-refractory essential tremor (ET) has been shown to significantly improve severity of limb tremor in several large case series with significant reduction in objective motor scores. A variable proportion of patients experience decline in benefit over time, however, most studies have not been designed to describe the phenomenon of waning benefit in terms that are helpful for patient counseling. In this retrospective single center study, we define waning benefit as a phenomenon that occurs after patients begin to require reprogramming visits to optimize DBS benefit on tremor. We employed a survival analysis with time to escape (TTE) as a quantitative measure of time elapsed between implantation and the need for subsequent reprogramming. In our cohort of ET patients operated on with Vim DBS from 1994 to 2009, among 45 subjects who met inclusion criteria, 73% reported waning benefit at some point during a mean follow-up period of 56 months (range 12-152 months). The mean TTE from implantation date was 18 months (range 3-75 months). We conclude that loss of benefit over time from Vim DBS for ET is more prevalent than previously published estimates have indicated and should be discussed during patient counseling regarding durability of expected benefit. In addition, this data suggests that a disease-based explanation rather than technical factors are more likely to explain the decline in benefit.
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Many patients with essential tremor eventually lose the benefit of deep brain stimulation because of disease progression or habituation.
“However, due to disease progression or habituation to stimulation, many patients lose the benefit of DBS over time [4].”
From Closed-loop DBS triggered by real-time movement and tremor decoding based on thalamic LFPs for essential tremor (2020) · cites this paper as [4]
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- Authors
- Shih, L. C., LaFaver, K., Lim, C., Papavassiliou, E., & Tarsy, D.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- National Institutes of Health (US)
- New York Medical College (US)
- Corresponding author
- Shih, Ludy C.
- Venue
- Parkinsonism & Related Disorders
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 19
- Issue
- 7
- Pages
- 676-679
- ISSN
- 1353-8020 (ISSN-L)
- OpenAlex
- W2050642306
- Cited by
- 100
- References
- 24
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 8 · 2023: 3 · 2022: 4 · 2021: 6 · 2020: 19 · 2019: 11 · 2018: 11 · 2017: 5 · 2016: 8 · 2015: 8 · 2014: 7
- FWCI
- 4.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Parkinsonism & Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Neurology › Botulinum Toxin and Related Neurological Disorders
- Keywords
- thalamic stimulation
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Time Factors, Survival Analysis, Treatment Outcome, Risk Assessment, Essential Tremor, Ventral Thalamic Nuclei, Deep Brain Stimulation
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