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Thalamic deep brain stimulation for the treatment of head, voice, and bilateral limb tremor. OBJECT: In published series of patients who undergo deep brain stimulation (DBS) of the thalamus the effects of unilateral stimulation on contralateral limb tremor have been reported. The authors detail their experience with bilateral thalamic DBS in the treatment of head, voice, and bilateral limb tremor and compare it with earlier studies of unilateral stimulation. METHODS: 23 patients (6 with Parkinson's disease, 15 with essential tremor, and 2 with multiple sclerosis) underwent 19 bilateral DBS procedures (9 staged, 10 simultaneous) and 4 procedures contralateral to thalamotomy to control tremor of the head in 10, voice in 7, and limbs in 20 patients. Limb tremor improvement was graded as follows: 4, no tremor; 3, stress-induced tremor; 2, functional improvement; 1, no functional improvement; and 0, persistent tremor. Improvement of head or voice tremor was graded as follows: 4, greater than 75%; 3, between 50% and 75%; 2, between 25% and 50%; 1, less than 25%; and 0, no improvement. The mean follow-up period was 10 months. 22 patients (96%) demonstrated improved tremor at the last follow-up review. Of 20 patients with bilateral limb tremor, 17 (85%) improved to Grades 3 and 4, 2 (10%) with multiple sclerosis improved to Grade 2, and 1 (5%) exhibited tremor recurrence 8 months later. 9 (90%) of 10 patients with severe head tremor improved to Grades 4 or 3. 6 (86%) of 7 patients with voice tremor improved to Grade 3. 7 patients (30%) developed dysarthria, and 7 (30%) developed disequilibrium; symptoms reversed in the majority of patients after the stimulation parameters were changed. 1 patient (4%) developed mild memory decline. There were no deaths. CONCLUSIONS: The following findings are reported: 1) bilateral thalamic DBS and stimulation contralateral to thalamotomy are safe; 2) staging the procedure does not reduce the risk of dysarthria or gait disequilibrium; and 3) head and voice tremor are primary indications for bilateral DBS. J Neurosurg 1999 Jul;91(1):68-72 Taha JM, Janszen MA, Favre J Department of Neurosurgery, University of Cincinnati College of Medicine and Mayfield Clinic, Ohio 45267-0515, USA. <[log in to unmask]> PMID: 10389882, UI: 99316744 <http://www.ncbi.nlm.nih.gov/PubMed> janet paterson 52 now / 41 dx / 37 onset snail-mail: PO Box 171 Almonte Ontario K0A 1A0 Canada website: a new voice <http://www.geocities.com/SoHo/Village/6263/> e-mail: <[log in to unmask]>