gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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

Meeting Abstract

  • corresponding author J.-U. Müller - Klinik für Neurochirurgie der E.-M.-Arndt-Universität Greifswald
  • A. Wolters - Klinik für Neurologie der Universität Rostock
  • J. Baldauf - Klinik für Neurochirurgie der E.-M.-Arndt-Universität Greifswald
  • R. Benecke - Klinik für Neurologie der Universität Rostock
  • H. W. S. Schroeder - Klinik für Neurochirurgie der E.-M.-Arndt-Universität Greifswald

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP025

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0293.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Müller et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

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.