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New Target Provides Better Tremor Control

Betty Bertram and her treatment team
After deep brain stimulation surgery for an essential tremor, Betty Bertram is better able to control the left side of her body. Left to right: Tao Xie, MD, PhD, associate professor of neurology; Betty Bertram, Catherine Ojakangas, PhD, assistant professor of surgery; and Peter Warnke, MD, associate professor of surgery.

Betty Bertram had the same surgery twice in one decade. While both were successful, the outcomes show how far medicine can progress in a short time.

In January, the 65-year-old Manteno, Illinois, resident underwent a unilateral deep brain stimulation (DBS)—an electrode implanted in the brain—at the University of Chicago to control the essential tremor afflicting the left side of her body. Eight years prior, she had a DBS procedure to control the tremor on the right side of her body.

The tremors, Bertram said, were debilitating and left her helpless at performing simple daily activities.

“I couldn’t feed myself, I couldn’t write,” she said. “I was getting to the point where I didn’t want to be social.”

Bertram still experiences a slight residual tremor on her right side. Her most recent surgery, however, showcases how far research has come—Bertram has no residual tremor after her second DBS.

The second surgery targeted a more precise place in her brain—the caudal zona incerta, just below the ventral intermediate thalamic nucleus—explained Peter Warnke, MD, associate professor of surgery, and Tao Xie, MD, PhD, assistant professor of neurology, who co-lead a multidisciplinary team of experts for the surgical program.

Warnke and Xie detected the caudal zona incerta location using recordings of microelectrodes as they passed through the different brain structures. When they reached a quiet grouping of neurons—the ones that needed to fire in order to control Bertram’s tremor—they knew they’d found the ideal spot for electrode implantation.

Not only does caudal zona incerta placement better control tremors, it doesn’t require as much voltage to do so, meaning less battery drainage and fewer surgeries to replace the battery pack conducting the current to the electrodes. And more important, it’s given Bertram a better post-surgery life.

“Having these surgeries has made me want to go out and do things again,” Bertram said. “The surgeries have given me that confidence.”

Watch a video of Bertram demonstrating the difference DBS has made at

November 2011

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Before & After Deep Brain Stimulation

View before and after video footage of the effect of deep brain stimulation on Betty Betram's essential tremor.

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