Funding agencies: FUS treatments were previously funded by the FUS Foundation, not specifically for this study.
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Research Article
Functional assessment and quality of life in essential tremor with bilateral or unilateral DBS and focused ultrasound thalamotomy
Version of Record online: 17 NOV 2015
DOI: 10.1002/mds.26455
© 2015 International Parkinson and Movement Disorder Society
Additional Information
How to Cite
Huss, D. S., Dallapiazza, R. F., Shah, B. B., Harrison, M. B., Diamond, J. and Elias, W. J. (2015), Functional assessment and quality of life in essential tremor with bilateral or unilateral DBS and focused ultrasound thalamotomy. Mov. Disord., 30: 1937–1943. doi: 10.1002/mds.26455
Relevant conflicts of interest/financial disclosures: Nothing to report.
Full financial disclosures and author roles may be found in the online version of this article.
Publication History
- Issue online: 16 DEC 2015
- Version of Record online: 17 NOV 2015
- Manuscript Accepted: 30 SEP 2015
- Manuscript Revised: 13 AUG 2015
- Manuscript Received: 8 MAR 2015
- Abstract
- Article
- References
- Cited By
Keywords:
- essential tremor;
- deep brain stimulation;
- focused ultrasound;
- thalamotomy;
- quality of life
Abstract
Background
Thalamic deep brain stimulation (DBS) has largely replaced radiofrequency thalamotomy as the treatment of choice for disabling, medication-refractory essential tremor. Recently, the development of transcranial, high-intensity focused ultrasound has renewed interest in thalamic lesioning. The purpose of this study is to compare functional outcomes and quality of life in essential tremor patients treated with either bilateral Vim DBS or unilateral procedures (focused ultrasound or DBS). We hypothesized that all three would effectively treat the dominant hand and positively impact functional outcomes and quality of life as measured with the Clinical Rating Scale for Tremor and the Quality of Life in Essential Tremor Questionnaire.
Methods
This is a retrospective study of medication-refractory essential tremor patients treated at the University of Virginia with bilateral Vim DBS (n = 57), unilateral Vim DBS (n = 13), or unilateral focused ultrasound Vim thalamotomy (n = 15). Tremor was rated for all patients before and after treatment, using the Clinical Rating Scale for Tremor and Quality of Life in Essential Tremor Questionnaire.
Results
Patients undergoing bilateral DBS treatment had more baseline tremor and worse quality of life scores. Patients had significant improvements in tremor symptoms and quality of life with all three treatments. Both DBS procedures improved axial tremor. No difference was seen in the degree of improvement in upper extremity tremor score, disability, or overall quality of life between bilateral and either unilateral procedure.
Conclusions
Bilateral thalamic DBS improves overall tremor more than unilateral DBS or focused ultrasound treatment; however, unilateral treatments are equally effective in treating contralateral hand tremor. Despite the greater overall tremor reduction with bilateral DBS, there is no difference in disability or quality of life comparing bilateral versus unilateral treatments. © 2015 International Parkinson and Movement Disorder Society
