or J.E.A.) at the time of the original diagnosis. 1 All 24 patients flagged by the search strategy had been evaluated by a senior movement disorders specialist (J.Y.M. These are the same search terms previously used to define the clinical characteristics of BTP.
#Tremulous movemnt plus#
The resulting records were then subjected to a text-based search for the keywords benign tremulous parkinsonism and benign tremulous Parkinson's disease plus the broader search terms tremor predominant parkinsonism and tremor predominant Parkinson's disease.
To identify all appropriate cases, we searched the Mayo Clinic Rochester medical linkage system for patients undergoing DBS between January 1, 1996, and July 31, 2010. This retrospective study was approved by the Mayo Clinic Institutional Review Board. For these reasons, we performed a retrospective review of all patients with BTP who have been treated with DBS at the Mayo Clinic, Rochester, Minnesota. In addition, it is not clear from the literature which of the 3 targets would be most appropriate for this subset of patients.
#Tremulous movemnt series#
1 - 3Īlthough DBS targeting the globus pallidus pars interna, subthalamic nucleus (STN), or thalamic nucleus ventralis intermedius (VIM) has been shown to be effective for the levodopa-responsive resting tremor of PD, to our knowledge, no published series has specifically focused on the effect of DBS on BTP.
1 In the few existing publications that focus on BTP, the reported clinical characteristics are generally consistent: prominent resting plus action tremor, mild generalized parkinsonism apart from tremor but sparing gait (except for reduced arm swing or stooped posture), only mild progression or disability apart from tremor, and lack of a robust response to levodopa. Although there is increasing knowledge regarding the long-term outcome of DBS for PD, little has been published about the use of DBS for other parkinsonian conditions.īenign tremulous parkinsonism (BTP) is a condition in the phenotypic spectrum of parkinsonism but with an uncertain pathophysiologic relationship to PD. Further studies are needed to explore the long-term durability of response and to better compare the surgical targets.ĭeep brain stimulation (DBS) is efficacious and is approved by the US Food and Drug Administration for the treatment of advanced, levodopa-responsive Parkinson disease (PD) and medically refractory essential tremor. No patients experienced adverse events after the surgical procedure.Ĭonclusions These findings support the efficacy of DBS, with VIM and STN targets, in medically refractory BTP-related tremor. Median time between the 2 videotapes was 11.5 months (range, 3-14 months). The median preoperative Fahn-Tolosa-Marin tremor scale score was 17 (range, 11-21) the tremor scale score at the last videotaped follow-up was 1 (range, 0-6). At last follow-up at a median of 4 years post-DBS, 7 patients were tremor free, 6 had only trace tremor, and 2 were definitely improved but with residual tremor. Results Of the 15 patients, 8 underwent unilateral thalamic nucleus ventralis intermedius (VIM), 4 bilateral VIM, and 3 bilateral subthalamic nucleus DBS. Main Outcome Measures Tremor status after DBS, preoperative vs postoperative scores on the Fahn-Tolosa-Marin tremor scale, and the presence of adverse events. Patients Twelve men and 3 women with BTP who underwent DBS for levodopa-refractory tremor. Objectives To assess the clinical outcomes and surgical complications of patients with BTP who underwent DBS. Deep brain stimulation (DBS) should be efficacious for this condition, but there is no previously published experience. This disorder has an uncertain pathophysiologic relationship to idiopathic Parkinson disease. Shared Decision Making and Communicationīackground Benign tremulous parkinsonism (BTP) is characterized by prominent resting plus action tremor, mild parkinsonism with limited disability or progression apart from tremor, and a less-robust response to levodopa therapy.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.
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