gms | German Medical Science

Objective: Deep brain stimulation is an established treatment in movement disorders. Movement disorders following brain lesions are rare and deep brain stimulation in these cases is always an individual decision. To reassess results of our surgical indications we compiled our cases. Our department realized more than 800 surgeries since 1999, mostly in patients with Parkinson’s disease, essential tremor and dystonia.

Method: We report on our eight patient case series with post lesion movement disorders, their indications, lesion positions, target points, stimulation parameters and overall outcome after deep brain stimulation between the years 2002 - 2014.

Results: Unilateral deep brain surgery was initiated in all eight patients, final implantation of electrodes in seven. Five patients presented with post lesion Holmes tremor, one patient with posttraumatic parkinson disease, one with hemidystonia and one with a Dystonic-jerky-unsteady-hand-syndrom (DJUHS). In one patient suffering from post traumatic hemidystonia and in the patient with the DJUHS on the right side we implanted unilateral ventralis oralis anterior (VOA) thalamic electrode. In five patients with post lesion holmes tremor we targeted the contralateral Nucleus ventralis intermedius of the thalamus. In one patient presenting with postraumatic Parkinson’s disease we implanted unilateral subthalamic and ventralis intermedius electrodes simultaneoulsy. All surgeries were performed under local anesthesia. Seven out of eight patients had significant symptom improvement, one patient with Holmes tremor was tested intraoperatively and showed no significant effect, therefore no electrode was implanted. From the beginning of stimulation a significant reduction of target symptoms appeared with up to complete disappearance. This effect was ongoing until now with a medium follow-up of 36 months.

Conclusions: In consent with published data, deep brain stimulation for Holmes tremor and other rare post- lesion movement disorders may reduce the symptoms and improve the overall quality of life. Since therapy may fail, individual diagnosis should be strictly analyzed and the indication for surgery has to be an individual decision depending on the individual clinical presentation of the patient.