{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:00:48Z","timestamp":1783774848039,"version":"3.55.0"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2010,3]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Microelectrode recording (MER) and macrostimulation (test stimulation) are used to refine the optimal deep brain stimulation (DBS) lead placement within the operative setting. It is well known that there can be a microlesion effect with microelectrode trajectories and DBS insertion. The aim of this study was to determine the impact of intraoperative MER and lead placement on tremor severity in a cohort of patients with essential tremor.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Consecutive patients with essential tremor undergoing unilateral DBS (ventral intermediate nucleus stimulation) for medication-refractory tremor were evaluated. Tremor severity was measured at 5 time points utilizing a modified Tremor Rating Scale: 1) immediately before MER; 2) immediately after MER; 3) immediately after lead implantation; 4) 6 months after DBS implantation in the off-DBS condition; and 5) 6 months after implantation in the on-DBS condition. To investigate the impact of the MER and DBS lead placement, Wilcoxon signed-rank tests were applied to test changes in tremor severity scores over the surgical course. In addition, a generalized linear mixed model including factors that potentially influenced the impact of the microlesion was also used for analysis.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Nineteen patients were evaluated. Improvement was noted in the total modified Tremor Rating Scale, postural, and action tremor scores (p &lt; 0.05) as a result of MER and DBS lead placement. The improvements observed following lead placement were similar in magnitude to what was observed in the chronically programmed clinic setting parameters at 6 months after lead implantation. Improvement in tremor severity was maintained over time even in the off-DBS condition at 6 months, which was supportive of a prolonged microlesion effect. The number of macrostimulation passes, the number of MER passes, and disease duration were not related to the change in tremor severity score over time.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Immediate improvement in postural and intention tremors may result from MER and DBS lead placement in patients undergoing DBS for essential tremor. This improvement could be a predictor of successful DBS lead placement at 6 months. Clinicians rating patients in the operating room should be aware of these effects and should consider using rating scales before and after lead placement to take these effects into account when evaluating outcome in and out of the operating room.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2009.7.jns09150","type":"journal-article","created":{"date-parts":[[2009,8,7]],"date-time":"2009-08-07T12:12:58Z","timestamp":1249647178000},"page":"491-496","source":"Crossref","is-referenced-by-count":48,"title":["Brain penetration effects of microelectrodes and deep brain stimulation leads in ventral intermediate nucleus stimulation for essential tremor"],"prefix":"10.3171","volume":"112","author":[{"given":"Takashi","family":"Morishita","sequence":"first","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly D.","family":"Foote","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel S.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon L.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ihtsham U.","family":"Haq","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa S.","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wake Forest University, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene A.","family":"Malaty","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Hass","sequence":"additional","affiliation":[{"name":"Applied Physiology and Kinesiology, Movement Disorders Center, University of Florida, McKnight Brain Institute, Gainesville;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Okun","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"},{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-1120491","series-title":"Neurosurgery","first-page":"722","article-title":"Risk factors for hemorrhage during microelectrode-guided deep brain stimulator implantation for movement disorders","volume":"56","author":"Binder","year":"2005"},{"key":"b2-1120491","series-title":"Mov Disord","first-page":"1062","article-title":"Bilateral subthalamic nucleus deep brain stimulation for advanced PD: correlation of intraoperative MER and postoperative MRI with neuropathological findings","volume":"18","author":"Counelis","year":"2003"},{"key":"b3-1120491","series-title":"N Engl J Med","first-page":"956","article-title":"Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease","volume":"345","author":"Deep Brain Stimulation for Parkinson's Disease Study Group","year":"2001"},{"issue":"14 Suppl","key":"b4-1120491","series-title":"Mov Disord","first-page":"S219","article-title":"Deep brain stimulation: postoperative issues","volume":"21","author":"Deuschl","year":"2006"},{"key":"b5-1120491","series-title":"AJNR Am J Neuroradiol","first-page":"1093","article-title":"Chronic thalamic stimulation with threedimensional MR stereotactic guidance","volume":"18","author":"Dormont","year":"1997"},{"key":"b6-1120491","series-title":"Neurosurgery","first-page":"754","article-title":"Reoperation for suboptimal outcomes after deep brain stimulation surgery","volume":"63","author":"Ellis","year":"2008"},{"key":"b7-1120491","series-title":"Stereotact Funct Neurosurg","first-page":"157","article-title":"Do microelectrode techniques increase accuracy or decrease risks in pallidotomy and deep brain stimulation? 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