Early Experience with the VerciseTM DBS System in the Treatment of Dystonic Tremor

Abstract

Six cases of dystonic tremor were treated with the VerciseTM deep brain stimulation(DBS)system, which has the multiple independent current control(MICC)technology. The mean preoperative score of Burke-Fahn-Marsden dystonia rating scale was 16.2±9.4, which was reduced to 6.1±4.6 at 5 months postoperatively. A 65-year-old male presented an intractable dystonic tremor of the jaw, neck, and shoulders due to tardive syndrome. He experienced the successful tremor relief after unipolar DBS in the globus pallidus internus(GPi)with VerciseTM but complained of dysarthria. Steering the current ventrally induced nausea without alleviating dysarthria, while steering the current dorsally alleviated dysarthria but a further dorsal current induced mandibular dyskinesia. The current steering with MICC enabled the simulation field in GPi with successful balance, maximizing tremor suppression, and minimizing the adverse effects. In a second case, 61-year-old male in whom cervical dystonia with rotatory tremor had been successfully treated with interleaving stimulation of GPi-DBS had needed to repeat the replacement of a non-rechargeable pulse generator in only 15-month interval. After the substitution of VerciseTM, the interleaving stimulation of 9.5mA in total was replaced by 8.5mA with the current steering of MICC, while the patient's symptomatic control was unchanged. The microlesion effects after lead implantation are unclear and therapeutic effects are often delayed in cases of dystonia;therefore, the submaximal stimulation intensities must be frequently applied in the early phase following the implantation of DBS. A fine current steering of VerciseTM DBS is very useful in both, the early and late phases of GPi-DBS for dystonic syndrome.