New study on essential tremor

Contemporary "brain pacemaker" avoids speech disorders

Familial tremor - called medically Essential Tremor - is the most common neurological movement disorder. According to the International Essential Tremor Foundation (IETF) is concerned about 65 years of which about one-fifth of the people. Essential tremor is characterized by a tremor of the arms and hands, but often the head or legs.

it can be treated with deep brain stimulation - where it has often occurred speech disorders. Neurologist at the University Hospital of Cologne have now found a way to avoid this. The result of a new study on erschient 18.02.2014 in the internationally renowned trade journal Neurology.

"The suffering of our patients in everyday life is hardly imaginable for us as Healthy. You have trouble writing, eating and more. Unfortunately this also help medications in many cases insufficient. "reports Prof. Dr. Lars Timmermann, a neurologist at the University Hospital of Cologne. The targeted placement of electrodes for deep brain stimulation (so-called "brain pacemaker") in a particular target region in the brain (thalamus and subthalamic region), the tremor usually be reduced by more than 80 percent. This is also in the patients of the case are not adequately responsive to medication.

The electrodes have four contacts, which are activated as needed and action by the neurologist with a certain current at their ends. In many patients, the optimal effect of deep brain stimulation can be achieved only by a nasty side effect: The language of the patient deteriorates.

One assumes that important nerves are irritated by the stimulation for speaking. Many of the patients no longer tremble indeed, however, the patient no longer speak clearly, they can each syllables poor to no longer separate. "Thus far often had the strength of stimulation are reduced again, which however in turn complete control of jitter is reduced," explains Dr. Michael Barbe, also a neurologist at the University Hospital of Cologne. This presents a dilemma for both the patient and the attending physician.

The working group movement disorders and deep brain stimulation to Prof. Timmermann and Dr. Barbe has now succeeded to investigate precisely which occurs after surgery speech disorder in an interdisciplinary approach. They found a way to allow the affected patient both good suppression of jitter, and louder.

With the help of a new generation of "brain pacemakers" it is possible to stimulate on several points of contact of the electrode with different currents. The difference: So far, though could also buy several contacts are activated - but only with the same strength. An individual stimulation by the individual contacts below the side effects limit was not previously possible.

In the study, at the Department of Stereotactic and Functional Neurosurgery of the University Hospital of Cologne was involved under the direction of Prof. Dr. Veerle Visser-Vandewalle, it could be shown that an individualized distribution of electricity via two contacts with the same amount of electricity, the same reduction the jitter provides but without a serious deterioration in the speech.

This proof-of-principle study (proof of concept), which in Neurology, one of the leading international newspapers, appeared on 18.02.2014, shows that an individualized breakdown of the current field over several contacts allows fewer side effects brain pacemaker therapy, without the desired effect on the tremor to lose.

"This could help us in the future, with stimulation caused speech disorders to improve in patients language, without the effect of impairing the tremors," said Dr. Barbe would. In principle, the results on patients with Parkinson's disease or dystonia example transmitted, which are treated with deep brain stimulation.

Original work:

NEUROLOGY / 2013 / 539205: Individualized current-shaping Reduces DBS-induced dysarthria in essential tremor patients. Michael Barbe, Till Dembek, John Becker, Jan Raethjen, Mariam Hartinger, Ingo champion, Matthias Runge, Mohammad Maarouf, Gereon Fink, and Lars Timmermann

Source: Köln [University Hospital]