Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Mar;74(3):305–311. doi: 10.1136/jnnp.74.3.305

Neuropsychological and quality of life outcomes 12 months after unilateral thalamic stimulation for essential tremor

J Fields 1, A Troster 1, S Woods 1, C Higginson 1, S Wilkinson 1, K Lyons 1, W Koller 1, R Pahwa 1
PMCID: PMC1738322  PMID: 12588913

Abstract

Objectives: To evaluate the one year cognitive, mood state, and quality of life (QoL) outcomes of unilateral thalamic deep brain stimulation (DBS) for essential tremor (ET).

Methods: 40 patients diagnosed with ET completed comprehensive neuropsychological assessments about one month before and three and 12 months after DBS electrode implantation. Data were subjected to multivariate analyses, and significant results were further analysed using univariate techniques.

Results: Analyses revealed statistically significant improvements on a cognitive screening measure and in aspects of fine visuomotor and visuoperceptual functions, verbal memory, mood state, and QoL. No group-wise declines in cognition were observed, but more patients showed declines than improvements on language and visual memory tests. Semantic verbal fluency declined significantly in four (10%) of the patients. In these four patients, diminished lexical verbal fluency was present at baseline.

Conclusion: Cognitive, mood, and QoL outcomes after one year of DBS for ET are favourable; there were no overall deleterious effects on cognition, and DBS was accompanied by a significant reduction in anxiety and improvements in quality of life. However, preoperative verbal fluency diminution may predispose to further fluency declines after DBS.

Full Text

The Full Text of this article is available as a PDF (149.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bejjani B. P., Damier P., Arnulf I., Thivard L., Bonnet A. M., Dormont D., Cornu P., Pidoux B., Samson Y., Agid Y. Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med. 1999 May 13;340(19):1476–1480. doi: 10.1056/NEJM199905133401905. [DOI] [PubMed] [Google Scholar]
  2. Blond S., Caparros-Lefebvre D., Parker F., Assaker R., Petit H., Guieu J. D., Christiaens J. L. Control of tremor and involuntary movement disorders by chronic stereotactic stimulation of the ventral intermediate thalamic nucleus. J Neurosurg. 1992 Jul;77(1):62–68. doi: 10.3171/jns.1992.77.1.0062. [DOI] [PubMed] [Google Scholar]
  3. Caparros-Lefebvre D., Blond S., Pécheux N., Pasquier F., Petit H. Evaluation neuropsychologique avant et après stimulation thalamique chez 9 parkinsoniens. Rev Neurol (Paris) 1992;148(2):117–122. [PubMed] [Google Scholar]
  4. Findley L. J. Epidemiology and genetics of essential tremor. Neurology. 2000;54(11 Suppl 4):S8–S13. [PubMed] [Google Scholar]
  5. Gasparini M., Bonifati V., Fabrizio E., Fabbrini G., Brusa L., Lenzi G. L., Meco G. Frontal lobe dysfunction in essential tremor: a preliminary study. J Neurol. 2001 May;248(5):399–402. doi: 10.1007/s004150170181. [DOI] [PubMed] [Google Scholar]
  6. Gálvez-Jiménez N., Hargreave M. Topiramate and essential tremor. Ann Neurol. 2000 Jun;47(6):837–838. doi: 10.1002/1531-8249(200006)47:6<837::aid-ana24>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  7. Higginson C. I., Fields J. A., Tröster A. I. Which symptoms of anxiety diminish after surgical interventions for Parkinson disease? Neuropsychiatry Neuropsychol Behav Neurol. 2001 Apr-Jun;14(2):117–121. [PubMed] [Google Scholar]
  8. Hubble J. P., Busenbark K. L., Wilkinson S., Penn R. D., Lyons K., Koller W. C. Deep brain stimulation for essential tremor. Neurology. 1996 Apr;46(4):1150–1153. doi: 10.1212/wnl.46.4.1150. [DOI] [PubMed] [Google Scholar]
  9. Hugdahl K., Wester K. Lateralized thalamic stimulation: effects on verbal memory. Neuropsychiatry Neuropsychol Behav Neurol. 1997 Jul;10(3):155–161. [PubMed] [Google Scholar]
  10. Johnson M. D., Ojemann G. A. The role of the human thalamus in language and memory: evidence from electrophysiological studies. Brain Cogn. 2000 Mar;42(2):218–230. doi: 10.1006/brcg.1999.1101. [DOI] [PubMed] [Google Scholar]
  11. Koller W. C., Hristova A., Brin M. Pharmacologic treatment of essential tremor. Neurology. 2000;54(11 Suppl 4):S30–S38. [PubMed] [Google Scholar]
  12. Koller W., Pahwa R., Busenbark K., Hubble J., Wilkinson S., Lang A., Tuite P., Sime E., Lazano A., Hauser R. High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol. 1997 Sep;42(3):292–299. doi: 10.1002/ana.410420304. [DOI] [PubMed] [Google Scholar]
  13. Lacritz Laura H., Dewey Richard, Jr, Giller Cole, Cullum C. Munro. Cognitive functioning in individuals with "benign" essential tremor. J Int Neuropsychol Soc. 2002 Jan;8(1):125–129. doi: 10.1017/s1355617702001121. [DOI] [PubMed] [Google Scholar]
  14. Lombardi W. J., Woolston D. J., Roberts J. W., Gross R. E. Cognitive deficits in patients with essential tremor. Neurology. 2001 Sep 11;57(5):785–790. doi: 10.1212/wnl.57.5.785. [DOI] [PubMed] [Google Scholar]
  15. Lucas J. A., Rippeth J. D., Uitti R. J., Shuster E. A., Wharen R. E. Neuropsychological functioning in a patient with essential tremor with and without bilateral VIM stimulation. Brain Cogn. 2000 Mar;42(2):253–267. doi: 10.1006/brcg.1999.1103. [DOI] [PubMed] [Google Scholar]
  16. Lücking C. H., Köster B., Guschlbauer B., Lauk M., Timmer J. Parkinsonian and essential tremors: different entities or different manifestations of the same disorder? Adv Neurol. 1999;80:335–339. [PubMed] [Google Scholar]
  17. Meador K. J. Effects of topiramate on cognition. J Neurol Neurosurg Psychiatry. 2001 Jul;71(1):134–135. doi: 10.1136/jnnp.71.1.134a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Murdoch B. E. Subcortical brain mechanisms in speech and language. Folia Phoniatr Logop. 2001 Sep-Oct;53(5):233–251. doi: 10.1159/000052679. [DOI] [PubMed] [Google Scholar]
  19. Pillon B., Ardouin C., Damier P., Krack P., Houeto J. L., Klinger H., Bonnet A. M., Pollak P., Benabid A. L., Agid Y. Neuropsychological changes between "off" and "on" STN or GPi stimulation in Parkinson's disease. Neurology. 2000 Aug 8;55(3):411–418. doi: 10.1212/wnl.55.3.411. [DOI] [PubMed] [Google Scholar]
  20. Saint-Cyr J. A., Trépanier L. L., Kumar R., Lozano A. M., Lang A. E. Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease. Brain. 2000 Oct;123(Pt 10):2091–2108. doi: 10.1093/brain/123.10.2091. [DOI] [PubMed] [Google Scholar]
  21. Straits-Tröster K., Fields J. A., Wilkinson S. B., Pahwa R., Lyons K. E., Koller W. C., Tröster A. I. Health-related quality of life in Parkinson's disease after pallidotomy and deep brain stimulation. Brain Cogn. 2000 Apr;42(3):399–416. doi: 10.1006/brcg.1999.1112. [DOI] [PubMed] [Google Scholar]
  22. Thompson P. J., Baxendale S. A., Duncan J. S., Sander J. W. Effects of topiramate on cognitive function. J Neurol Neurosurg Psychiatry. 2000 Nov;69(5):636–641. doi: 10.1136/jnnp.69.5.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Tröster A. I., Fields J. A., Pahwa R., Wilkinson S. B., Strait-Tröster K. A., Lyons K., Kieltyka J., Koller W. C. Neuropsychological and quality of life outcome after thalamic stimulation for essential tremor. Neurology. 1999 Nov 10;53(8):1774–1780. doi: 10.1212/wnl.53.8.1774. [DOI] [PubMed] [Google Scholar]
  24. Tröster A. I., Wilkinson S. B., Fields J. A., Miyawaki K., Koller W. C. Chronic electrical stimulation of the left ventrointermediate (Vim) thalamic nucleus for the treatment of pharmacotherapy-resistant Parkinson's disease: a differential impact on access to semantic and episodic memory? Brain Cogn. 1998 Nov;38(2):125–149. doi: 10.1006/brcg.1998.1025. [DOI] [PubMed] [Google Scholar]
  25. Tröster A. I., Woods S. P., Fields J. A., Lyons K. E., Pahwa R., Higginson C. I., Koller W. C. Neuropsychological deficits in essential tremor: an expression of cerebello-thalamo-cortical pathophysiology? Eur J Neurol. 2002 Mar;9(2):143–151. doi: 10.1046/j.1468-1331.2002.00341.x. [DOI] [PubMed] [Google Scholar]
  26. Woods S. P., Fields J. A., Lyons K. E., Koller W. C., Wilkinson S. B., Pahwa R., Tröster A. I. Neuropsychological and quality of life changes following unilateral thalamic deep brain stimulation in Parkinson's disease: a one-year follow-up. Acta Neurochir (Wien) 2001 Dec;143(12):1273–1278. doi: 10.1007/s007010100024. [DOI] [PubMed] [Google Scholar]
  27. Woods Steven Paul, Fields Julie A., Tröster Alexander I. Neuropsychological sequelae of subthalamic nucleus deep brain stimulation in Parkinson's disease: a critical review. Neuropsychol Rev. 2002 Jun;12(2):111–126. doi: 10.1023/a:1016806711705. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES