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Voice Tremor Response to Deep Brain Stimulation in Relation to Electrode Location in the Posterior Subthalamic Area
Umeå University, Faculty of Medicine, Department of Clinical Sciences.ORCID iD: 0000-0002-7626-2889
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Clinical Sciences.ORCID iD: 0000-0003-3373-0934
2019 (English)In: World Neurosurgery: X, ISSN 2590-1397, Vol. 3, p. 1-9, article id 100024Article in journal (Refereed) Published
Abstract [en]

Background: Deep brain stimulation of the motor thalamus or the posterior subthalamic area (PSA) shows promising results for patients with voice tremor, although only for about 50% of patients. There are indications that voice tremor requires more focused stimulation within the target area compared with hand tremor. The objective of the present study was to determine the most efficient location for reducing voice tremor within the PSA.

Methods: Thirty-seven patients with essential tremor were evaluated off stimulation and in a set of experimental conditions with unilateral stimulation at increasing amplitude levels. Two listeners performed blinded assessments of voice tremor from recordings of sustained vowel productions.

Results: Twenty-five patients (68%) had voice tremor. Unilateral stimulation reduced voice tremor for the majority of patients, and only 6 patients had poor outcomes. Contacts yielding efficient voice tremor reduction were deeper relative to the midcommissural point (MCP) and more posterior relative to the posterior tip of the subthalamic nucleus (pSTN) (z MCP = –3.1, y pSTN = –0.2) compared with poor contacts (z MCP = –0.7, y pSTN = 1.0). High-amplitude stimulation worsened voice tremor for 7 patients and induced voice tremor in 2 patients. Hand tremorimproved to a greater extent than voice tremor, and improvements could be seen throughout the target area.

Conclusions: Our results indicate that efficient voice tremor reduction can be achieved by stimulating contacts located in the inferior part of the PSA, close or slightly posterior to the pSTN. We observed cases in which voice tremor was induced by high-amplitude stimulation.

Place, publisher, year, edition, pages
2019. Vol. 3, p. 1-9, article id 100024
National Category
Other Medical Sciences not elsewhere specified
Research subject
Neurosurgery; Oto-Rhino-Laryngology
Identifiers
URN: urn:nbn:se:umu:diva-158712DOI: 10.1016/j.wnsx.2019.100024Scopus ID: 2-s2.0-85063299409OAI: oai:DiVA.org:umu-158712DiVA, id: diva2:1314223
Projects
Röst och tal efter djup hjärnstimulering för patienter med Parkinsons sjukdom och essentiell tremorAvailable from: 2019-05-08 Created: 2019-05-08 Last updated: 2019-05-15Bibliographically approved

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