Neurology Book


Thalamic Stimulation

Aka: Thalamic Stimulation, Deep Brain Stimulation
  1. Indications
    1. Severe refractory Parkinson's Disease (motor fluctuations, Dyskinesias, Tremor)
  2. Contraindications: Relative
    1. Dementia
    2. Untreated Major Depression
    3. Severe postural instability
    4. Atypical Parkinsonism
  3. Description
    1. Electrode implanted at thalamic region causing Tremor (Subthalamic Nucleus or Globus Pallidus interna)
    2. Wire exits skull and into modified Pacemaker
    3. Pacemaker delivers high frequency stimulus
    4. Results in good efficacy of Tremor suppression
  4. Complications: Similar catastrophic risk as Thalamotomy
    1. Death
    2. Intracranial Hemorrhage
    3. CNS Infection
    4. Lead Fracture, migration or misplacement
    5. Cerebrovascular Accident
      1. Paralysis
      2. Aphasia
      3. Cognitive deficit
    6. Other effects
      1. Fall Risk
      2. Major Depression
      3. New onset parasthesias
  5. Prognosis: Predictors of good response to surgery
    1. Good response to Levodopa
    2. Minimal comorbid conditions
    3. Cognitive Impairment absent
    4. Major Depression absent or controlled
  6. Efficacy
    1. Improved on-time, motor function and quality of life
    2. Does not slow Parkinson's Disease progression
  7. References
    1. Bronstein (2011) Arch Neurol 68(2): 165-71 [PubMed]
    2. Deuschl (2006) N Engl J Med 355(9): 896-908 [PubMed]
    3. Halli-Tierney (2020) Amf fam Physician 102(11):679-91 [PubMed]
    4. Weaver (2009) JAMA 301(1): 63-73 [PubMed]

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