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janvier

Find STN target to stop tremor when there is no tremor?

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DBS is done when the patient is awake because the surgeon relies on the patient's reactions to pinpoint exactly the location of the electrode to be placed. If a PD patient has tremor on one side, but has absolutely no tremor and no other symptom on the other side, is bilateral STN still recommended? If yes how can or can the surgeon really spot the target for the side which does not have any symptoms at all? What is the recommended approach for such a case? If the risk of not being able to find the other side's target precisely is high then is unilateral STN a solution or can unilateral VIM be considered?

Thanks for the response.

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Most experienced DBS groups no longer perform bilateral DBS unless there is a specific symptom to address on the opposite side. There is a lot of evidence that 1/3 or more of patients may not require a second opposite side DBS and that patients should not rush in. There are side effects of adding a second lead (walking, talking, etc.).

 

As for target, STN and GPi are preferred for PD because VIM only addresses the tremor. Some centers feel that upper extremity tremor is best treated with VIM if there is a cognitive risk to surgery--- but most centers favor STN or GPi.

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Thanks for the response Dr Okun. If my interpretation is correct unilateral tremor with absolutely nothing on the other side makes bilateral STN superfluous with an extra lead placed without hitting a precise target in the brain. Such an operation as I understand is increasing the risk unnecessarily without gaining any advantage for the future. Thus in the described case unilateral STN or even VIM will solve the problem. Now a follow-up question is: What kind of a DBS intervention is needed if in the future if the same patient gets mainly tremor on the other side of the body considering he/she has unilateral STN or unilateral VIM?

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We tend not to use VIM if possible, as STN or even GPi will help with the rigidity and bradykinesia.

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