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Keywords:

  • essential tremor;
  • Parkinson's disease;
  • ventralis intermedius nuclei deep brain stimulation;
  • thalamic stimulation;
  • computerized posturography

Abstract

Bilateral ventralis intermedius nuclei (Vim) deep brain stimulation (DBS) improves tremor in patients with both essential tremor (ET) and Parkinson's disease (PD). In each condition, patients have individually noted both subjective improvement and worsening in balance. Computerized posturography (CP) is able to quantify some aspects of balance. Twenty-one patients (8 with PD and 13 with ET) with bilateral Vim DBS were recruited to undergo randomized-order identical CP testing (EquiTest system) while their DBS devices were both activated and deactivated. One PD patient could not complete any OFF assessment and is not included. Three PD patients could not tolerate portions of the OFF testing. Overall, sensory organization testing was improved by DBS activation in conditions that involved quiet standing with eyes open with no motion of the support surface, or with sway-referenced support surface motion, but worsened during quiet standing with eyes closed only in ET patients. Falls lessened with activation in ET patients. Motor control testing was not changed. Bilateral Vim DBS activation mostly improved balance, but may modestly worsen other specific features. © 2006 Movement Disorder Society