VIM Stimulation [Neurosurgery Wiki]

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====== VIM Stimulation ======

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Deep Brain Stimulation (DBS): In DBS procedures, electrodes are implanted into specific brain regions, including the VIM. These electrodes deliver controlled electrical impulses, modulating the abnormal neural activity associated with movement disorders and providing relief from symptoms like tremors.

[[Essential Tremor]] (ET): Essential tremor is a neurological disorder characterized by rhythmic and involuntary shaking, often affecting the hands. VIM-DBS has been shown to be effective in reducing tremors in individuals with essential tremor who do not respond well to medications.

Parkinson's Disease: While the primary target for DBS in Parkinson's disease is often the subthalamic nucleus, VIM-DBS may also be considered in some cases, especially for controlling tremors.

Programming and Adjustment: Following the implantation of electrodes, the DBS system needs to be carefully programmed and adjusted to achieve optimal symptom control while minimizing side effects. This process is typically done by neurologists or specialists with expertise in DBS programming.

Multidisciplinary Approach: The decision to pursue VIM-DBS or other surgical interventions involves a comprehensive evaluation by a multidisciplinary team, including neurologists, neurosurgeons, and other healthcare professionals.

Understanding the role of the ventral intermediate nucleus and its involvement in movement control is crucial for developing targeted therapies, particularly for individuals with movement disorders where abnormal neural activity in this region contributes to symptoms.

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[[Deep brain stimulation]] (DBS) in thalamic [[ventrointermediate nucleus]] ([[VIM]]) is the traditional target for the surgical treatment of pharmacologically refractory [[essential tremor]] (ET) or parkinsonian tremor. 

Studies  on DBS in the posterior subthalamic area (PSA), including the [[zona incerta]] (Zi) and the prelemniscal radiation (Raprl), have shown promising results in tremor suppression 
((Mundinger F. New stereotactic treatment of spasmodic torticollis with a brain stimulation system. Med Klin. 1977;72:1982–1986. German.))
((Brice J, McLellan L. Suppression of intension tremor by contingent deep-brain stimulation. Lancet. 1980;1:1221–1222.))
((Andy OJ. Thalamic stimulation for control of movement disorders. Appl Neurophysiol. 1983;46:107–111.))
((Kitagawa M, Murata J, Kikuchi S, Sawamura Y, Saito H, Sasaki H, Tashiro K. Deep brain stimulation of subthalamic area for severe proximal tremor. Neurology. 2000;55:114–116. doi: 10.1212/WNL.55.1.114.))
((Hooper J, Simpson P, Whittle IR. Chronic posttraumatic movement disorder alleviated by insertion of mesodiencephalic deep brain stimulating electrode. Neurosurgery. 2005;56:281–289.))
((Velasco F, Jimenez F, Perez ML, Carrillo-Ruiz JD, Velasco AL, Ceballos J, Velasco M. Electrostimulation of the prelemniscal radiation in the treatment of Parkinson's disease: an old target revised with new techniques. Neurosurgery. 2001;49:293–306.))
((Murata JI, Kitagawa M, Uesugi H, Saito H, Iwasaki Y, Kikuchi S, Tashiro K, Sawamura Y. Electrostimulation of the posterior subthalamic area for the treatment of intractable proximal tremor. J Neurosurg. 2003;99:708–715. doi: 10.3171/jns.2003.99.4.0708.))
((Nandi D, Aziz TZ. Deep Brain Stimulation in the Management of Neuropathic Pain and Multiple Sclerosis Tremor. J Clin Neurophysiol. 2004;21:31–39. doi: 10.1097/00004691-200401000-00005.))
((Plaha P, Patel NK, Gill SS. Stimulation of the subthalamic region for essential tremor. J Neurosurg. 2004;101:48–54. doi: 10.3171/jns.2004.101.1.0048.))
((Kitagawa M, Murata J, Uesugi H, Kikuchi S, Saito H, Tashiro K, Sawamura Y. Two-year follow-up of chronic stimulation of the posterior subthalamic white matter for tremor-dominant Parkinson's disease. Neurosurgery. 2005;56:281–289.))
((Plaha P, Ben-Shlomo Y, Patel NK, Gill SS. Stimulation of the caudal zona incerta is superior to stimulation of the subthalamic nucleus in improving contralateral parkinsonism. Brain. 2006;129:1732–1747. doi: 10.1093/brain/awl127.))
((Freund HJ, Barniko UB, Nolte D, Treuer H, Auburger G, Tass PA, Samii M, Sturm V. Subthalamic-thalamic DBS in a case with spinocerebellar ataxia type 2 and severe tremor-A unusual clinical benefit. Mov Disord. 2007;22:732–735. doi: 10.1002/mds.21338.))
((Hemel W, Herzog J, Kopper F, Pinsker M, Weinert D, Muller D, Krack P, Deuschl G, Mehdorn HM. Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor. Acta Neurochir (Wien) 2007;149:749–758. doi: 10.1007/s00701-007-1230-1.))
((Herzog J, Hamel W, Wenzelburger R, Potter M, Pinsker MO, Bartussek J, Morsnowski A, Steigerwald F, Deutschl G, Volkmann J. Kinetic analysis of thalamic versus subthalamic neurostimulation in postural and intention tremor. Brain. 2007;130:1608–1625. doi: 10.1093/brain/awm077.))
((Carrillo-Ruiz JD, Velasco F, Jimenez F, Castro G, Velasco AL, Hernandez JA, Ceballos J, Velasco M. Bilateral Electrostimulation of prelemniscal radiations in the treatment of advanced Parkinson's disease. Neurosurgery. 2008;62:347–357. doi: 10.1227/01.neu.0000316001.03765.e8.))
((Plaha P, Khan S, Gill SS. Bilateral stimulation of the caudal zona incerta nucleus for tremor control. J Neurol Neurosurg Psychiatry. 2008;79:504–513. doi: 10.1136/jnnp.2006.112334.))
((Blomstedt P, Fytagoridis A, Tisch S. Deep brain stimulation of the posterior subthalamic area in the treatment of tremor. Acta Neurochir. 2009;151:31–36. doi: 10.1007/s00701-008-0163-7.))
((Blomstedt P, Sandvik U, Tisch S. Deep brain stimulation in the posterior subthalamic area in the treatment of essential tremor. Mov Disord. 2010;25:1350–1356. doi: 10.1002/mds.22758.))
((Fytagoridis A, Blomstedt P. Complications and side effects of deep brain stimulation in the posterior subthalamic area. Stereotact Funct Neurosurg. 2010;88:88–93. doi: 10.1159/000271824.))
((Barbe MT, Liebhart L, Runge M, Deyng J, Florin E, Wojtecki L, Schnitzler A, Allert N, Sturm V, Fink GR, Maarouf M, Timmermann L. Deep brain stimulation of the ventral intermediate ucleus in patients with essential tremor: stimulation below intercommissural line is more efficient but equally effective as stimulation above. Exp Neurol. 2011;230:131–137. doi: 10.1016/j.expneurol.2011.04.005.))
((Blomstedt P, Sandvik U, Linder J, Fredricks A, Forsgren L, Hariz MI. Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor. Acta Neurochia (Wien) 2011;153:2329–2335. doi: 10.1007/s00701-011-1157-4.))
((Blomstedt P, Lindvall P, Linder J, Olivecrona M, Forsgren L, Hariz MI. Reoperation after failed deep brain stimualiton for essential tremor. World Neurosurg. 2011. Dec [Epub ahead of print]))
((Blomstedt P, Sandvik U, Hariz MI, Fytagoridis A, Forsgren L, Hariz GM, Koskinen LD. Influence of age, gender and severity of tremor on outcome after thalamic and subthalamic DBS for essential tremor. Parkinosnism Relat Disord. 2011;17:617–620. doi: 10.1016/j.parkreldis.2011.05.014.))
((Blomstedt P, Fytagoridis A, Astrom M, Linder J, Forsgren L, Hariz MI. Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor. Parkinsonism Relat Disord. 2012. June 13 [Epub ahead of print]))
((Fytagoridis A, Sandvik U, Astrom M, Bergenheim T, Blomstedt P. Long term follow-up of deep brain stimulation of the caudal zona incerta for essential tremor. J Neurol Neurosurg Psychiatry. 2012;83:258–262. doi: 10.1136/jnnp-2011-300765.)).
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Side effects of Vim stimulation include: [[paresthesia]]s, H/A, [[dysequilibrium]], [[dysarthria]], [[dystonia]] &
localized [[pain]].