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Treatment of tremor in Parkinson's disease by subthalamic nucleus stimulation†
Article first published online: 4 NOV 2004
Copyright © 1998 Movement Disorder Society
Volume 13, Issue 6, pages 907–914, November 1998
How to Cite
Krack, P., Benazzouz, A., Pollak, P., Limousin, P., Piallat, B., Hoffmann, D., Xie, J. and Benabid, A.-L. (1998), Treatment of tremor in Parkinson's disease by subthalamic nucleus stimulation. Mov. Disord., 13: 907–914. doi: 10.1002/mds.870130608
- Issue published online: 4 NOV 2004
- Article first published online: 4 NOV 2004
- Manuscript Accepted: 8 JUN 1998
- Manuscript Revised: 6 MAR 1998
- Manuscript Received: 1 AUG 1997
- Parkinson's disease;
- Subthalamic nucleus;
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.