caa a22 4500 445807946 CHVBK 20180317145202.0 cr unu---uuuuu 170323e20110901xx s 000 0 eng 10.1007/s00415-011-5986-0 doi (NATIONALLICENCE)springer-10.1007/s00415-011-5986-0 Steady or not following thalamic deep brain stimulation for essential tremor [Elektronische Daten] [Nelson Hwynn, Christopher Hass, Pamela Zeilman, Janet Romrell, Yunfeng Dai, Sam Wu, Kelly Foote, S. Subramony, Genko Oyama, Frances Velez-Lago, Hubert Fernandez, Andrew Resnick, Irene Malaty, Michael Okun] Deep brain stimulation (DBS) has become an important option for medication-refractory essential tremor (ET), but may contribute to worsened gait and falling. This study evaluates impaired gait in a cohort of patients treated with DBS with a retrospective review of ET patients before and after DBS implantation. Factors examined included: age, duration of symptoms, pre-morbid gait difficulties/falls, Fahn-Tolosa-Marin tremorrating scale (TRS) scores at baseline, 6months post-unilateral DBS implantation, and 6 or 12months post-bilateral implantation. All implantations targeted the nucleus ventralis intermediate (Vim). Thirty-eight patients (25 males, 13 females) were included. Twenty-five patients (65.8%) underwent unilateral DBS implantation and 13 (34.2%) bilateral. The mean age at surgery was 67.1years±11.4 (range 34-81). The mean disease duration was 31years±18.3 (range 6-67). Fifty-eight percent of patients had worsened gait post-operatively. Seventy percent of patients with unilateral Vim DBS experienced gait worsening while 55% of bilateral DBS patients experienced gait worsening. Patients with worsened gait post-DBS had higher baseline pre-operative TRS scores than those without worsened gait (43.1 points±8.4 vs. 33.1 points±10.1, p=0.002) (odds ratio 2.5, p=0.02). Gait/balance may worsen following DBS for medication refractory ET. Higher baseline TRS score may factor into these issues, although a larger prospective study will be required with a control population. The larger percentage of difficulties observed in unilateral versus bilateral cases likely reflected the bias to not proceed to second-sided surgery if gait/balance problems were encountered. Springer-Verlag, 2011 Tremor nationallicence Surgery/stimulation nationallicence Gait nationallicence Thalamus nationallicence Vim nationallicence Hwynn Nelson Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut Hass Christopher College of Human and Health Performance, University of Florida, Gainesville, USA aut Zeilman Pamela Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut Romrell Janet Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut Dai Yunfeng Division of Biostatistics, Department of Statistics, University of Florida, Gainesville, USA aut Wu Sam Division of Biostatistics, Department of Statistics, University of Florida, Gainesville, USA aut Foote Kelly Center for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, USA aut Subramony S. Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut Oyama Genko Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut Velez-Lago Frances Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut Fernandez Hubert Cleveland Clinic, Center for Neurologic Restoration, Cleveland, USA aut Resnick Andrew Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut Malaty Irene Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut Okun Michael Center for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, USA aut Journal of Neurology Springer-Verlag 258/9(2011-09-01), 1643-1648 0340-5354 258:9<1643 2011 258 415 https://doi.org/10.1007/s00415-011-5986-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00415-011-5986-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hwynn Nelson Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut NATIONALLICENCE 700 1- Hass Christopher College of Human and Health Performance, University of Florida, Gainesville, USA aut NATIONALLICENCE 700 1- Zeilman Pamela Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut NATIONALLICENCE 700 1- Romrell Janet Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut NATIONALLICENCE 700 1- Dai Yunfeng Division of Biostatistics, Department of Statistics, University of Florida, Gainesville, USA aut NATIONALLICENCE 700 1- Wu Sam Division of Biostatistics, Department of Statistics, University of Florida, Gainesville, USA aut NATIONALLICENCE 700 1- Foote Kelly Center for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, USA aut NATIONALLICENCE 700 1- Subramony S. Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut NATIONALLICENCE 700 1- Oyama Genko Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut NATIONALLICENCE 700 1- Velez-Lago Frances Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut NATIONALLICENCE 700 1- Fernandez Hubert Cleveland Clinic, Center for Neurologic Restoration, Cleveland, USA aut NATIONALLICENCE 700 1- Resnick Andrew Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut NATIONALLICENCE 700 1- Malaty Irene Department of Neurology, McKnight Brain Institute, University of Florida, 100 S. Newell Drive, Rm L3-100, 32610, Gainesville, Fl, USA aut NATIONALLICENCE 700 1- Okun Michael Center for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, USA aut NATIONALLICENCE 773 0- Journal of Neurology Springer-Verlag 258/9(2011-09-01), 1643-1648 0340-5354 258:9<1643 2011 258 415 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer