Article
Bilateral deep brain stimulation of the nucleus ventralis intermedius for therapy-refractory posttraumatic Holmes tremor: a case report
Bilaterale Tiefenhirnstimulation im Ncl. ventralis intermedius bei therapieresistenten posttraumatischen Holmes-Tremor: ein Fallbericht
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Published: | May 4, 2005 |
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Outline
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Objective
We report on a patient with a manifest Holmes tremor due to a traumatic head injury 8 years before. The symptoms were dominated by a left-sided irregular postural and a kinetic tremor with a frequency of 3-4 Hz of the upper extremities and the trunk. In additional, a resting tremor was obvious. All medical treatment options to relieve these tremors failed.
Methods
MR-imaging excluded an anatomic lesion of the basal ganglia. A bilateral stereotactic implantation of deep brain stimulation (DBS) electrodes (model 3387; Medtronic) was performed in the nucleus ventralis intermedius, near the transition to the zona incerta. The procedure was done under electrophysiological control. The stereotactic coordinates of the target regions of the DBS electrode tips with respect to the intercommissural line were as followed: x-axis 12.5 mm bilaterally, y-axis 6 mm anterior of the commissura posterior, z-axis 2 mm below on the left and 1 mm below on the right. A Kinetra-stimulator (modell 7428; Medtronic) was implanted for chronic stimulation.
Results
Postoperatively, the resting tremor as well as the kinetic tremor resolved completely immediately after starting stimulation, especially for the postural component of the kinetic tremor. This improvement was of considerable clinical functional benefit enabling the patient to perform fine hand movements as well as relevant goal-directed movements. Tremor of the trunk was only partly improved. No complications related to surgery or stimulation occurred. Furthermore, medical therapy could be completely withdrawn.
Conclusions
A positive effect on a posttraumatic Holmes tremor by continuous bilateral DBS in the nucleus ventralis intermedius - when applied near the transition to the zona incerta - can be observed in selected patients. The clinical functional benefit seems to be considerable and results in a higher quality of life.