Randomised Crossover Trial of Deep Brain Stimulation of Differential Posterior Subthalamic Area Regions in Parkinson's Disease and Tremor
Randomised Crossover Trial of Deep Brain Stimulation of Differential Posterior Subthalamic Area Regions in Parkinson's Disease and Tremor
The posterior subthalamic area holds promise as a target region for deep brain stimulation in
 tremor and Parkinson's disease. Using the magnetic resonance-directed implantable guide tube
 surgical technique, subregions of the posterior subthalamic area can be individually
 targetted on a single electrode lead trajectory. The hypothesis is that the caudal zona
 incerta may provide improved control of movement disorder symptoms than the more commonly
 stimulated dorsal zona incerta.
Randomisation between two treatment locations each programmed up to 3 milliamps in amplitude
 for 3 months: (1) caudal zona incerta and (2) dorsal zona incerta. This 6-month-long
 randomised phase is followed by 6 months of unblinded individualised empirically optimised
 settings programmed by a neurologist. Each of the three treatment periods ends with a full
 clinical, functional and quality of life assessment.
Inclusion Criteria:

 -  Medication-refractory tremor and/or Parkinson's disease as defined by UK Brain Bank
 criteria with either inadequate control of motor fluctuations or dyskinesia despite
 optimised medical therapy

 Exclusion Criteria:

 -  Significant cognitive, psychiatric and medical co-morbidities

 -  Dementia with mini mental state examination score of less than 25/30

 -  Limited life expectancy due to a co-morbid condition