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Table 1 PSA DBS publications: indications, targets, results and side effects

From: Post subthalamic area deep brain stimulation for tremors: a mini-review

Series (reference number) Patients/procedures/time to assess Target and/or stereotactic parameters Results Side effects
Mundinger, 1977 [1] 7 torticollis, unilateral, stimulation 30-40 minutes. cZi; in some cases combined with other structures Good control of the torticollis No
Brice and McLellan, 1980 [2] 2 MS, bilateral, post-op 6 months 10mm lateral/20mm behind AC/6–8mm below ICL (AC: anterior commissure; ICL: inter-commissural line) “Striking improvement” in intention tremor Transient worsening of swallowing, speech, and micturition, all resolved in 3 weeks but dysarthria.
Andy, 1983 [3] 1 PTT, unilateral 7mm lateral/ 8.5mm behind MCP/1mm below ICL (MCP: middle-commissural point) Complete cessation of tremor Unknown
Kitagawa et al., 2000 [4] 1 ET and 1 DT, unilateral, intra-op stimulation and post-op 1 week Zi, 3 mm under the border of the VIM Abolition of ET; “remarkable” decrease in DT and dystonia Transient paresthesia, palm hyperhidrosis, anorexia, and disequilibrium
Hooper et al., 2001 [5] 1 PTT, unilateral, post-op 44 months 12mm lateral/ 6mm behind MCP/4mm below ICL Sustained microtomy effect. No IPG needed. Shoulder weakness, resolved in 3 days.
Velasco et al., 2001 [6] 10 PD, unilateral, post-op 12 months Expressed in tenths of the ICL: laterality 5/10, 8/10 behind AC, 1–2/10 below ICL, targeting Raprl Significant improvement in tremor and rigidity; Mild improvement in bradykinesia. 1 worsening pre-existing depression, 1 transient diplopia, 3 transient dysarthria
Murata et al., 2003 [7] 8 ET, unilateral, post-op 22 months (8-42) Best 11mm lateral/7.5mm behind MCP/4mm below ICL in Zi and Raprl Contralateral tremor decreased by 81% Only stimulation induced that did not affect result.
Nandi and Aziz, 2004 [8] 15 MS, 6 bilateral, 9 unilateral, post-op 15 months in 10 patients Zi Contralateral postural tremor decreased by 64%, intention tremor by 36% Transient paresthesia, mild dysarthria and seizure in 1 and infection in 2 patients.
Plaha et al., 2004 [9] 4 ET, bilateral, post-op 12 months Medial to the posterior dorsal third of the STN Total tremor decreased by 80%. 2 patients with severe head tremor completely resolved. No tolerance. Low volt 1.8. No dysarthria or dysequilibrium.
Kitagawa et al., 2005 [10] 8 PD, unilateral, post-op 24 months Best contact 10.5mm lateral/5.6mm behind MCP/ 3.2mm below ICL UPDRS-III improved by 44.3%, tremor by 78.3%, rigidity by 92.7% and akinesia by 65.7%. Mild adverse events
Plaha et al., 2006 [11] 35 PD, 29 bilateral, 6 unilateral, post-op 6 months cZi: posteromedial to the post-dorsal STN cZi better than STN in reducing UPDRSIII by 76%, tremor by 93%, rigidity by 76% and bradykinesia by 65% in cZi vs by 55%, 61%, 50% and 59% in STN. No complication in Zi No difference in dyskinesia, L-dopa reduction, and stimulation parameters.
Freund et al., 2007 [12] 1 SCA2, bilateral, post-op 2 years Combined VOP-VIM/Zi-Cerebellar thalamic projection (VOP: ventro-oralis posterior). Nearly complete cessation of tremor and torticollis by stimulation to distal contacts No complication mentioned
Hamel et al., 2007 [13] 8 ET, 2 MS, 1 SCA, bilateral, post-op at least 3 months, most of them > 1year 12.7mm lateral/7mm behind MCP/1.5mm below ICL Reducing intention tremor by 68% to 73%. PSA better than VIM unless limited by side effects Paresthesia, dysarthria, gait ataxia, unknown number
Herzog et al., 2007 [14] 10ET, bilateral, and 11MS, 6 bilateral, 5 unilateral, post-op at least 4 months In PSA region, no details PSA better than VIM in postural and intention tremors reduction, by 64% in ET and by 50% in MS. Unknown
Carrillo-Ruiz et al., 2008 [15] 5 PD, bilateral, post-op 12 months Active contacts: 11.5mm/ 6.5mm behind MCP and 4.5mm below ICL UPDRS III decreased by 65%, tremor by 90%, rigidity by 94%, bradykinesia by 75% 1 deterioration of pre-existing depression, 5 transient somnolence, 1 transient dysarthria
Plaha et al., 2008 [16] 6 ET, 5 PD, 4 MS, 1 CT, 1 HT, 1 DT/bilateral, post-op 12 months Posteromedial to the posterodorsal STN PD tremor improved by 92%, rigidity by 77%, bradykinesia by 62%. Tremor improved in ET by 76%; MS, 57%; CT, 60%; HT, 70%; DT, 71%. Low volts 2 transient dysequilibrium, 1 transient dysphagia
Blomstedt et al., 2009 [17] 2DT,1 WC (writer's cramp),1CT, all unilateral, post-op 1 year Active 10.3mm/6.1mm behind MCP/3.5 below ICL, in PSA 87% tremor reduction Unknown
Blomstedt et al., 2010 [18] 21ET, 2 bilateral, 19 unilateral, post-op 1 year. PSA active contact 11.6mm lateral/6.3mm behind MCP/3mm below ICL. Reducing tremor of upper extremity by 95%, hand function by 87%, improving ADL by 66%. 8 transient expressive dysphasia, 1 transient clumsy hand and leg.
Fytagoridis and Blomstedt, 2010 [19] 27 ET, 8 PD, 2 DT, 1 CT, 1 WC, all unilateral except 4 bilateral, unknown disease, post-op 34 months Active 12.0mm/6.1mm behind MCP/1.5mm below ICL, all in PSA 24 non-PD tremor decreased by 91% 1 transient hemiparesis, 1 infection, 22% transient dysphasia.
Barbe et al., 2011 [20] 21ET, bilateral 19, 2 unilateral, post-op at least 3 months 26 sub- ICL and 14 above ICL electrodes. The mean sub-ICL 11.3mm lateral/7.2mm behind MCP/1.4mm below ICL, the thalamic 12.6mm lateral/5.7mm behind MCP/1.0mm above ICL. Sub-ICL stimulation is more efficient than thalamic stimulation but equally effective when patients’ individual stimulation parameters are used. Paresthesia in 3/26, and dysarthria in 2/26 electrodes
Blomstedt et al., 2011 [21] 4 ET unilateral, one in STN one in cZi, post-op 1-6 years cZi 9.5-15.5mm lateral/1.3-9.4mm behind MCP/0.2mm above to 6.8mm below ICL cZi more efficient than STN Comparable, dysarthria, dystonia, dizziness, blurred vision.
Blomstedt et al., 2011 [22] 5ET, failed VIM, no info on post-op duration except in “years” cZi, 11.4mm lateral/6.8mm behind MCP/2.9mm below ICL cZi achieved improvement in tremor control after VIM failed, 57% cZi vs 25% VIM Unknown
Blomstedt et al., 2011 [23] 68 ET, 34VIM and 34 PSA, only 3 each bilateral, post-op 28 months for VIM and 12 month for PSA. Vim 13-15mm lateral/6-7mm before PC/0mm on ICL. PSA: posteromedial to the tail of the STN at the level of maxim diameter red nucleus (PC: posterior commissure) Tremor in the treated hand improved by 70% in VIM and 89% in PSA. Unknown
Blomstedt et al., 2012 [24] 14 PD, 13 unilateral, 1 bilateral, post-op 18 months Posterior and medial to the posterior tail of the STN at the maximal diameter of the RN. Active contact 12.6mm lateral/7mm post MCP/2mm below ICL Tremor reduction by 82.2%, rigidity by 34.3%, bradykinesia by 26.7% 1 stimulation induced side effect, 1 infection
Fytagoridis et al., 2012 [25] 18 ET, 16 unilateral and 2 bilateral, post-op 4 years on average cZi, 12.0mm lateral/6.3mm behind MCP/2.2mm below ICL, in posterior-medial to STN at the level of the maximal diameter of red nucleus Improved total tremor by 51.4%, upper extremity by 89.4%, hand function by 78.5%. No increase in stimulation over the course Mild and transient, 1 hard ware related.