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Peraio S, Mantovani G, Araceli T, Mongardi L, Noris A, Fino E, Formica F, Piccinini L, Melani F, Lenge M, Scalise R, Battini R, Di Rita A, D'Incerti L, Appleton T, Cavallo MA, Guerrini R, Giordano F. Unilateral deep brain stimulation (DBS) of nucleus ventralis intermedius thalami (Vim) for the treatment of post-traumatic tremor in children: a multicentre experience. Childs Nerv Syst 2024:10.1007/s00381-024-06380-1. [PMID: 38573550 DOI: 10.1007/s00381-024-06380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Deep brain stimulation (DBS) of nucleus ventralis intermedius thalami (Vim) is a validated technique for the treatment of essential tremor (ET) in adults. Conversely, its use for post traumatic tremor (PTT) and in paediatric patients is still debated. We evaluated the efficacy of Vim-DBS for lesional tremor in three paediatric patients with drug-resistant post-traumatic unilateral tremor. METHODS We retrospectively collected data regarding three patients with unilateral tremor due to severe head injury, with no MRI evidence of basal ganglia lesions. The three patients underwent stereotactic frame-based robot-assisted DBS of Vim contralateral to the tremor side. RESULTS Mean follow-up was 48 months (range: 36-60 months). Tremor was reduced in all patients with a better control of voluntary movements and improvement of functional status (mean FIM scale improvement + 7 points). No surgical complications occurred. CONCLUSION Unilateral contralateral DBS of Vim could be efficacious in post-traumatic tremor, even in paediatric patients and should be offered in PTT drug-resistant patients.
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Affiliation(s)
- Simone Peraio
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giorgio Mantovani
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Tommaso Araceli
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Lorenzo Mongardi
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Alice Noris
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Edoardo Fino
- Pediatric Neurology Clinic - Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | - Francesca Formica
- Istituto Medea "La Nostra Famiglia" IRCCS, Bosisio Parini, LC, Italy
| | - Luigi Piccinini
- Istituto Medea "La Nostra Famiglia" IRCCS, Bosisio Parini, LC, Italy
| | - Federico Melani
- Pediatric Neurology Clinic - Meyer Children's Hospital IRCCS, Florence, Italy
| | - Matteo Lenge
- Pediatric Neurology Clinic - Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Roberta Scalise
- Istituto Stella Maris - IRCCS - University of Pisa, Pisa, Italy
| | - Roberta Battini
- Istituto Stella Maris - IRCCS - University of Pisa, Pisa, Italy
| | - Andrea Di Rita
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ludovico D'Incerti
- Department of Radiology, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | | | - Renzo Guerrini
- Pediatric Neurology Clinic - Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
| | - Flavio Giordano
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
- University of Florence, Florence, Italy
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Kamo H, Oyama G, Ito M, Iwamuro H, Umemura A, Hattori N. Deep brain stimulation in posterior subthalamic area for Holmes tremor: Case reports with review of the literature. Front Neurol 2023; 14:1139477. [PMID: 37034086 PMCID: PMC10076748 DOI: 10.3389/fneur.2023.1139477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Background Holmes tremor (HT) is a refractory tremor associated with cortico-basal ganglia loops and cerebellothalamic tract abnormalities. Various drug treatments have been attempted; however, no treatment method has yet been established. Historically, thalamic deep brain stimulation (DBS) has been performed in medically refractory cases. Recently, the posterior subthalamic area (PSA) has been used for HT. Here, we report cases of HT and review the effectiveness and safety of PSA-DBS for HT. Cases We conducted a retrospective chart review of two patients with HT who underwent PSA-DBS. Improvement in tremors was observed 1 year after surgery without apparent complications. Literature review We identified 12 patients who underwent PSA-DBS for HT, including our cases. In six patients, PSA was targeted alone; for the rest, the ventralis intermediate nucleus (Vim) of the thalamus and PSA were simultaneously targeted. The Fahn-Tolosa-Marin Tremor Rating Scale improvement rates were 56.8% (range, 33.9-82.1%; n = 6) and 77.8% (range, 42.6-100%; n = 5) for the PSA-DBS and PSA+Vim-DBS, respectively. Conclusion Reasonable improvements in HT were observed after PSA-DBS. PSA might be an appropriate target for improving the symptoms of HT. Long-term observations, accumulation of cases, and randomized studies are required in future.
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Affiliation(s)
- Hikaru Kamo
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Neurodegenerative and Demented Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Home Medical Care System Based on Information and Communication Technology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Drug Development for Parkinson's Disease, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of PRO-Based Integrated Data Analysis in Neurological Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masanobu Ito
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
| | - Hirokazu Iwamuro
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsushi Umemura
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Neurodegenerative and Demented Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Home Medical Care System Based on Information and Communication Technology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Drug Development for Parkinson's Disease, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of PRO-Based Integrated Data Analysis in Neurological Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Neurodegenerative Disorders Collaborative Laboratory, RIKEN Center for Brain Science, Wako, Japan
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Adhikari A, Bhattarai AM, Pandit A, Rokaya P, Khadka M, Shahi M, Baiju S, Poudel R. Benedikt syndrome in a 74-year-old hypertensive woman: A case report. Clin Case Rep 2022; 10:e6767. [PMID: 36545564 PMCID: PMC9764039 DOI: 10.1002/ccr3.6767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Benedikt syndrome is a rare neurological disorder of the midbrain. Herein, we present a case of Benedikt syndrome, who presented with left-sided body weakness, right oculomotor nerve palsy, cerebellar ataxia, and Holmes tremor in the left upper limb following midbrain infarction. She was treated with aspirin, clopidogrel, and amiodarone.
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Affiliation(s)
| | | | - Ayushma Pandit
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Pooja Rokaya
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Manoj Khadka
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | | | - Swastika Baiju
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Raju Poudel
- Department of NeurologyGrande International HospitalKathmanduNepal
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Evolving Concepts in Our Understanding and Treatment of Holmes Tremor, Over 100 Years in the Making. Tremor Other Hyperkinet Mov (N Y) 2022; 12:18. [PMID: 35651920 PMCID: PMC9138737 DOI: 10.5334/tohm.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/13/2022] [Indexed: 11/20/2022] Open
Abstract
Holmes Tremor (HT) is an irregular, slow-frequency (<4.5 Hz) tremor characterized by a combination of resting, postural, and action tremors mostly of the upper extremities. Symptoms of HT typically emerge 4 weeks to 2 years after a brain injury caused by a spectrum of etiologies. HT pathophysiology is thought to result from aberrant collateral axonal sprouting and synaptic dysfunction following neuronal damage. To date, the dopaminergic nigrostriatal system, cerebello-thalamo-cortical pathway, and dentate-rubro-olivary pathway have all been implicated in the clinical manifestations of HT. The diversity of HT etiologies usually requires a personalized treatment plan. Current treatment options include carbidopa-levodopa, levetiracetam, and trihexyphenidyl, and surgical management such as deep brain stimulation in selected medication-refractory patients. In this review we discuss the pathophysiology, etiology, neuroimaging, and the latest clinical guidelines for care and management of HT.
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Bargiotas P, Nguyen TAK, Bracht T, Mürset M, Nowacki A, Debove I, Muellner J, Michelis JP, Pollo C, Schüpbach WMM, Lachenmayer ML. Long-Term Outcome and Neuroimaging of Deep Brain Stimulation in Holmes Tremor: A Case Series. Neuromodulation 2021; 24:392-399. [PMID: 33389771 DOI: 10.1111/ner.13352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Different deep brain stimulation (DBS) targets have been suggested as treatment for patients with pharmacologically refractory Holmes tremor (HT). We report the clinical and quality of life (QoL) long-term (up to nine years) outcome in four patients with HT treated with DBS (in thalamic ventral intermediate nucleus-VIM or in dentato-rubro-thalamic tract-DRTT). MATERIALS AND METHODS The patients underwent routine clinical evaluations before and after DBS (typically annually). Tremor severity and activities of daily living (ADL) were quantified by the Fahn-Tolosa-Marin Tremor-Rating-Scale (FTMTRS). QoL was assessed using the RAND SF-36-item Health Survey (RAND SF-36). In addition, we computed, in all four patients, the VTA based on the best stimulation settings using heuristic approaches included in the open source toolbox LEAD-DBS. RESULTS In all patients, tremor and ADL improved significantly at one-year post-DBS follow-up (34-61% improvement in FTMTRS total score compared to baseline). In three out of four patients, the improvement of tremor was sustained no longer than two to three years and only in one patient was sustained up to nine years. In this patient, the largest intersection between VTA and DBS target has been observed. Scores for ADL deteriorated over the course of time, reaching worse levels compared to baseline already during the three-year post-DBS follow-up, in three out of four patients. Physical and mental health component scores of RAND SF-36 had very different outcome between patients and follow-ups and were not associated with tremor-related outcomes. CONCLUSIONS The benefits of DBS in HT might not be always long lasting. Although QoL slightly improved, this change seemed to be independent of the motor outcome following DBS. The estimation of DBS target and VTA proximity could be a useful tool for DBS clinicians in order to facilitate the DBS programming process and optimize DBS treatment.
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Affiliation(s)
- Panagiotis Bargiotas
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - T A Khoa Nguyen
- Department of Neurosurgery, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Tobias Bracht
- University Hospital of Psychiatry and Psychotherapy, University of Bern; Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Melina Mürset
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
| | - Julia Muellner
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
| | - Joan P Michelis
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
| | - W M Michael Schüpbach
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
| | - M Lenard Lachenmayer
- Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland
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Razmkon A, Yousefi O, Vaidyanathan J. Using Preimplanted Deep Brain Stimulation Electrodes for Rescue Thalamotomy in a Case of Holmes Tremor: A Case Report and Review of the Literature. Stereotact Funct Neurosurg 2020; 98:136-141. [PMID: 32209790 DOI: 10.1159/000506083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic stimulation of the thalamus is a surgical option in the management of intractable Holmes tremor. Patients with deep brain stimulation (DBS) can encounter infection as a postoperative complication, necessitating explantation of the hardware. Some studies have reported on the technique and the resulting efficacy of therapeutic lesioning through implanted DBS leads before their explantation. CASE DESCRIPTION We report the case of a patient with Holmes tremor who had stable control of symptoms with DBS of the nucleus ventralis intermedius of the thalamus (VIM) but developed localized infection over the extension at the neck, followed by gradual loss of a therapeutic effect as the neurostimulator reached the end of its service life. Three courses of systemic antibiotic therapy failed to control the infection. After careful consideration, we decided to make a rescue lesion through the implanted lead in the right VIM before explanting the complete DBS hardware. The tremor was well controlled after the rescue lesion procedure, and the effect was sustained during a 2-year follow-up period. CONCLUSION This case and the previously discussed ones from the literature demonstrate that making a rescue lesion through the DBS lead can be the last plausible option in cases where the DBS system has to be explanted because of an infection and reimplantation is a remote possibility.
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Affiliation(s)
- Ali Razmkon
- Research Center for Neuromodulation and Pain, Shiraz, Iran,
| | - Omid Yousefi
- Research Center for Neuromodulation and Pain, Shiraz, Iran
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O’Shea SA, Elkind M, Pullman SL, Ford B. Holmes Tremor due to Artery of Percheron Infarct: Clinical Case and Treatment Using Deep Brain Stimulation of the Vim and ZI Targets. Tremor Other Hyperkinet Mov (N Y) 2020; 10:tre-10-732. [PMID: 32195040 PMCID: PMC7070701 DOI: 10.7916/tohm.v0.732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/05/2019] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Holmes tremor (HT) arises from disruption of the cerebellothalamocortical pathways. A lesion can interrupt the projection at any point, resulting in this tremor. We describe a case of HT due to the rare artery of Percheron infarct and its successful treatment using deep brain stimulation. CASE REPORT A 62-year-old woman with a right medial cerebral peduncle and bilateral thalamic stroke developed HT. Ventral intermediate nucleus (Vim) zona incerta (ZI) deep brain stimulation (DBS) surgery was performed, with improvement in her tremor. DISCUSSION Our case supports the theory that the more caudal ZI target in combination with Vim is beneficial in treating poorly DBS-responsive tremors such as HT.
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Affiliation(s)
- Sarah A. O’Shea
- Department of Neurology, Boston University School of Medicine, Boston University, Boston, MA, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- To whom correspondence should be addressed. E-mail:
| | - Mitchell Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Seth L. Pullman
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Blair Ford
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Cheng G, Yang Y, Wang Y, Tan H, Zhang S. Deep brain stimulation of the thalamic ventral intermediate nucleus for Benedikt's syndrome mainly present as tremor: a long-term case observation. Acta Neurochir (Wien) 2018; 160:1349-1353. [PMID: 29600395 DOI: 10.1007/s00701-018-3526-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/21/2018] [Indexed: 02/05/2023]
Abstract
Benedikt's syndrome (BS) is caused by the lesion in the midbrain and specifically manifests a series of symptoms, including ipsilateral third nerve palsy, contralateral tremor, hemiataxia, and hyperactive tendon reflexes. Deep brain stimulation (DBS) for BS emerges as a new approach and achieves successfully results. We report a successful case report of thalamic ventral intermediate (VIM) nucleus DBS for a patient with BS. During follow-up of 3 years, DBS successfully control the tremor and greatly improve his living and working quality. We consider that VIM DBS may have sustained benefit for refractory BS that mainly presents as tremor.
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Affiliation(s)
- Guoxiong Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yuelong Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Hongyu Tan
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Shizhen Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China.
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Deep brain stimulation in uncommon tremor disorders: indications, targets, and programming. J Neurol 2018; 265:2473-2493. [PMID: 29511865 DOI: 10.1007/s00415-018-8823-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND In uncommon tremor disorders, clinical efficacy and optimal anatomical targets for deep brain stimulation (DBS) remain inadequately studied and insufficiently quantified. METHODS We performed a systematic review of PubMed.gov and ClinicalTrials.gov. Relevant articles were identified using the following keywords: "tremor", "Holmes tremor", "orthostatic tremor", "multiple sclerosis", "multiple sclerosis tremor", "neuropathy", "neuropathic tremor", "fragile X-associated tremor/ataxia syndrome", and "fragile X." RESULTS We identified a total of 263 cases treated with DBS for uncommon tremor disorders. Of these, 44 had Holmes tremor (HT), 18 orthostatic tremor (OT), 177 multiple sclerosis (MS)-associated tremor, 14 neuropathy-associated tremor, and 10 fragile X-associated tremor/ataxia syndrome (FXTAS). DBS resulted in favorable, albeit partial, clinical improvements in HT cases receiving Vim-DBS alone or in combination with additional targets. A sustained improvement was reported in OT cases treated with bilateral Vim-DBS, while the two cases treated with unilateral Vim-DBS demonstrated only a transient effect. MS-associated tremor responded to dual-target Vim-/VO-DBS, but the inability to account for the progression of MS-associated disability impeded the assessment of its long-term clinical efficacy. Neuropathy-associated tremor substantially improved with Vim-DBS. In FXTAS patients, while Vim-DBS was effective in improving tremor, equivocal results were observed in those with ataxia. CONCLUSIONS DBS of select targets may represent an effective therapeutic strategy for uncommon tremor disorders, although the level of evidence is currently in its incipient form and based on single cases or limited case series. An international registry is, therefore, warranted to clarify selection criteria, long-term results, and optimal surgical targets.
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Deep brain stimulation for lesion-related tremors: A systematic review and meta-analysis. Parkinsonism Relat Disord 2018; 47:8-14. [DOI: 10.1016/j.parkreldis.2017.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 12/28/2022]
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Elias GJB, Namasivayam AA, Lozano AM. Deep brain stimulation for stroke: Current uses and future directions. Brain Stimul 2017; 11:3-28. [PMID: 29089234 DOI: 10.1016/j.brs.2017.10.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/07/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of stroke often experience significant disability and impaired quality of life related to ongoing maladaptive responses and persistent neurologic deficits. Novel therapeutic options are urgently needed to augment current approaches. One way to promote recovery and ameliorate symptoms may be to electrically stimulate the surviving brain. Various forms of brain stimulation have been investigated for use in stroke, including deep brain stimulation (DBS). OBJECTIVE/METHODS We conducted a comprehensive literature review in order to 1) review the use of DBS to treat post-stroke maladaptive responses including pain, dystonia, dyskinesias, and tremor and 2) assess the use and potential utility of DBS for enhancing plasticity and recovery from post-stroke neurologic deficits. RESULTS/CONCLUSIONS A large variety of brain structures have been targeted in post-stroke patients, including motor thalamus, sensory thalamus, basal ganglia nuclei, internal capsule, and periventricular/periaqueductal grey. Overall, the reviewed clinical literature suggests a role for DBS in the management of several post-stroke maladaptive responses. More limited evidence was identified regarding DBS for post-stroke motor deficits, although existing work tentatively suggests DBS-particularly DBS targeting the posterior limb of the internal capsule-may improve paresis in certain circumstances. Substantial future work is required both to establish optimal targets and parameters for treatment of maladapative responses and to further investigate the effectiveness of DBS for post-stroke paresis.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Andrew A Namasivayam
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada.
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Rojas-Medina LM, Esteban-Fernández L, Rodríguez-Berrocal V, Del Álamo de Pedro M, Ley Urzaiz L, Bailly-Baillere IR. Deep Brain Stimulation in Posttraumatic Tremor: A Series of Cases and Literature Review. Stereotact Funct Neurosurg 2016; 94:379-386. [PMID: 27846626 DOI: 10.1159/000448078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 06/29/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posttraumatic tremor (PTT) is the most frequent movement disorder secondary to cranioencephalic trauma and can be persistent and disabling. OBJECTIVES We review and assess the efficacy of deep brain stimulation (DBS) at the VIM/VOP/ZI (ventralis intermedius/ventrooralis posterior/zona incerta) complex level for the treatment of PTT. METHODS During the period from 1999 to 2014, 5 patients diagnosed with PTT were selected who had experienced a major deterioration in their quality of life without improvement during medical treatment for more than 1 year. They underwent surgery for DBS at the VIM/VOP/ZI complex level, and the modified tremor scale before and after surgery was used for their follow-up. RESULTS Each patient showed improvements in their symptoms after DBS compared with baseline, which was moderate (II) in 2 cases and marked (III) in the other cases. All of the improvements were maintained with chronic DBS, without tremor rebound. CONCLUSIONS Stimulation of the contralateral VIM/VOP/ZI complex resulted in a noticeable improvement in tremor and recovery of independence in basic daily activities in patients with PTT.
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Boccard SGJ, Rebelo P, Cheeran B, Green A, FitzGerald JJ, Aziz TZ. Post-Traumatic Tremor and Thalamic Deep Brain Stimulation: Evidence for Use of Diffusion Tensor Imaging. World Neurosurg 2016; 96:607.e7-607.e11. [PMID: 27693821 DOI: 10.1016/j.wneu.2016.09.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a well-established treatment to reduce tremor, notably in Parkinson disease. DBS may also be effective in post-traumatic tremor, one of the most common movement disorders caused by head injury. However, the cohorts of patients often have multiple lesions that may impact the outcome depending on which fiber tracts are affected. CASE DESCRIPTION A 20-year-old man presented after road traffic accident with severe closed head injury and polytrauma. Computed tomography scan showed left frontal and basal ganglia hemorrhagic contusions and intraventricular hemorrhage. A disabling tremor evolved in step with motor recovery. Despite high-intensity signals in the intended thalamic target, a visual analysis of the preoperative diffusion tensor imaging revealed preservation of connectivity of the intended target, ventralis oralis posterior thalamic nucleus (VOP). This was confirmed by the postoperative tractography study presented here. DBS of the VOP/zona incerta was performed. Six months postimplant, marked improvement of action (postural, kinetic, and intention) tremor was achieved. CONCLUSIONS We demonstrated a strong connectivity between the VOP and the superior frontal gyrus containing the premotor cortex and other central brain areas responsible for movement control. In spite of an existing lesion in the target, the preservation of these tracts may be relevant to the improvement of the patient's symptoms by DBS.
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Affiliation(s)
- Sandra G J Boccard
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, Oxford, United Kingdom.
| | - Pedro Rebelo
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, Oxford, United Kingdom
| | - Binith Cheeran
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, Oxford, United Kingdom
| | - Alexander Green
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, Oxford, United Kingdom
| | - James J FitzGerald
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, Oxford, United Kingdom
| | - Tipu Z Aziz
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Departments of Clinical Neuroscience and Surgery, University of Oxford, Oxford, United Kingdom
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15
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Ramirez-Zamora A, Kaszuba BC, Gee L, Prusik J, Danisi F, Shin D, Pilitsis JG. Clinical Outcome and Characterization of Local Field Potentials in Holmes Tremor Treated with Pallidal Deep Brain Stimulation. Tremor Other Hyperkinet Mov (N Y) 2016; 6:388. [PMID: 27441097 PMCID: PMC4929492 DOI: 10.7916/d8s182jj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/13/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Holmes tremor (HT) is an irregular, low-frequency rest tremor associated with prominent action and postural tremors. Currently, the most effective stereotactic target and neurophysiologic characterization of HT, specifically local field potentials (LFPs) are uncertain. We present the outcome, intraoperative neurophysiologic analysis with characterization of LFPs in a patient managed with left globus pallidus interna deep brain stimulation (Gpi DBS). CASE REPORT A 24-year-old male underwent left Gpi DBS for medically refractory HT. LFPs demonstrated highest powers in the delta range in Gpi. At the 6-month follow-up, a 90% reduction in tremor was observed. DISCUSSION Pallidal DBS should be considered as an alternative target for management of refractory HT. LFP demonstrated neuronal activity associated with higher power in the delta region, similarly seen in patients with generalized dystonia.
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Affiliation(s)
| | | | - Lucy Gee
- Albany Medical College, Albany, NY, USA
| | | | - Fabio Danisi
- Kingston Neurological Associates, Kingston, NY, USA
| | | | - Julie G Pilitsis
- Albany Medical Center, Albany, NY, USA,Albany Medical College, Albany, NY, USA,*To whom correspondence should be addressed. E-mail:
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16
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di Biase L, Munhoz RP. Deep brain stimulation for the treatment of hyperkinetic movement disorders. Expert Rev Neurother 2016; 16:1067-78. [DOI: 10.1080/14737175.2016.1196139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Abstract
Introduction: Deep brain stimulation (DBS) has become a standard therapy for the treatment of select cases of medication refractory essential tremor and Parkinson’s disease however the effectiveness and long-term outcomes of DBS in other uncommon and complex tremor syndromes has not been well established. Traditionally, the ventralis intermedius nucleus (VIM) of the thalamus has been considered the main target for medically intractable tremors; however alternative brain regions and improvements in stereotactic techniques and hardware may soon change the horizon for treatment of complex tremors. Areas covered: In this article, we conducted a PubMed search using different combinations between the terms ‘Uncommon tremors’, ‘Dystonic tremor’, ‘Holmes tremor’ ‘Midbrain tremor’, ‘Rubral tremor’, ‘Cerebellar tremor’, ‘outflow tremor’, ‘Multiple Sclerosis tremor’, ‘Post-traumatic tremor’, ‘Neuropathic tremor’, and ‘Deep Brain Stimulation/DBS’. Additionally, we examined and summarized the current state of evolving interventions for treatment of complex tremor syndromes. Expertcommentary: Recently reported interventions for rare tremors include stimulation of the posterior subthalamic area, globus pallidus internus, ventralis oralis anterior/posterior thalamic subnuclei, and the use of dual lead stimulation in one or more of these targets. Treatment should be individualized and dictated by tremor phenomenology and associated clinical features.
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Affiliation(s)
| | - Michael S Okun
- b Department of Neurology , University of Florida Center for Movement Disorders and Neurorestoration , Gainesville FL , USA
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18
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Raina GB, Cersosimo MG, Folgar SS, Giugni JC, Calandra C, Paviolo JP, Tkachuk VA, Zuñiga Ramirez C, Tschopp AL, Calvo DS, Pellene LA, Uribe Roca MC, Velez M, Giannaula RJ, Fernandez Pardal MM, Micheli FE. Holmes tremor: Clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 2016; 86:931-8. [PMID: 26865524 PMCID: PMC4782118 DOI: 10.1212/wnl.0000000000002440] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical features, etiology, findings from neuroimaging, and treatment results in a series of 29 patients with Holmes tremor (HT). METHODS A retrospective study was performed based on review of medical records and videos of patients with HT diagnosis. RESULTS A total of 16 women and 13 men were included. The mean age at the moment of CNS insult was 33.9 ± 20.1 years (range 8-76 years). The most common causes were vascular (48.3%), ischemic, or hemorrhagic. Traumatic brain injury only represented 17.24%; other causes represented 34.5%. The median latency from lesion to tremor onset was 2 months (range 7 days-228 months). The most common symptoms/signs associated with HT were hemiparesis (62%), ataxia (51.7%), hypoesthesia (27.58%), dystonia (24.1%), cranial nerve involvement (24.1%), and dysarthria (24.1%). Other symptoms/signs were vertical gaze disorders (6.8%), bradykinesia/rigidity (6.8%), myoclonus (3.4%), and seizures (3.4%). Most of the patients had lesions involving more than one area. MRI showed lesions in thalamus or midbrain or cerebellum in 82.7% of the patients. Levodopa treatment was effective in 13 out of 24 treated patients (54.16%) and in 3 patients unilateral thalamotomy provided excellent results. CONCLUSIONS The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Treatment with levodopa and thalamic stereotactic lesional surgery seems to be effective.
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Affiliation(s)
- Gabriela B Raina
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Maria G Cersosimo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Silvia S Folgar
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan C Giugni
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Cristian Calandra
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan P Paviolo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Veronica A Tkachuk
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Carlos Zuñiga Ramirez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Andrea L Tschopp
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Daniela S Calvo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Luis A Pellene
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Marcela C Uribe Roca
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Miriam Velez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Rolando J Giannaula
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Manuel M Fernandez Pardal
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Federico E Micheli
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
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19
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Raina GB, Cersosimo MG, Folgar SS, Giugni JC, Calandra C, Paviolo JP, Tkachuk VA, Zuñiga Ramirez C, Tschopp AL, Calvo DS, Pellene LA, Uribe Roca MC, Velez M, Giannaula RJ, Fernandez Pardal MM, Micheli FE. Holmes tremor: Clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 2016. [PMID: 26865524 DOI: 10.1212/wnl.0000000000002440.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the clinical features, etiology, findings from neuroimaging, and treatment results in a series of 29 patients with Holmes tremor (HT). METHODS A retrospective study was performed based on review of medical records and videos of patients with HT diagnosis. RESULTS A total of 16 women and 13 men were included. The mean age at the moment of CNS insult was 33.9 ± 20.1 years (range 8-76 years). The most common causes were vascular (48.3%), ischemic, or hemorrhagic. Traumatic brain injury only represented 17.24%; other causes represented 34.5%. The median latency from lesion to tremor onset was 2 months (range 7 days-228 months). The most common symptoms/signs associated with HT were hemiparesis (62%), ataxia (51.7%), hypoesthesia (27.58%), dystonia (24.1%), cranial nerve involvement (24.1%), and dysarthria (24.1%). Other symptoms/signs were vertical gaze disorders (6.8%), bradykinesia/rigidity (6.8%), myoclonus (3.4%), and seizures (3.4%). Most of the patients had lesions involving more than one area. MRI showed lesions in thalamus or midbrain or cerebellum in 82.7% of the patients. Levodopa treatment was effective in 13 out of 24 treated patients (54.16%) and in 3 patients unilateral thalamotomy provided excellent results. CONCLUSIONS The most common causes of HT in our series were vascular lesions. The most common lesion topography was mesencephalic, thalamic, or both. Treatment with levodopa and thalamic stereotactic lesional surgery seems to be effective.
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Affiliation(s)
- Gabriela B Raina
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Maria G Cersosimo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Silvia S Folgar
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan C Giugni
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Cristian Calandra
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Juan P Paviolo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Veronica A Tkachuk
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Carlos Zuñiga Ramirez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Andrea L Tschopp
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Daniela S Calvo
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Luis A Pellene
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Marcela C Uribe Roca
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Miriam Velez
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Rolando J Giannaula
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Manuel M Fernandez Pardal
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru
| | - Federico E Micheli
- From Hospital de Clinicas "José de San Martin" (G.B.R., M.G.C., S.S.F., J.C.G., C.C., J.P.P., V.A.T., A.L.T., D.S.C., L.A.P., F.E.M.), Hospital Britanico (M.C.U.R., M.M.F.), and Hospital Español (R.J.G.), CABA, Buenos Aires, Argentina; Movement Disorders and Neurodegenerative Diseases Unit (C.Z.R.), Hospital Civil de Guadalajara "Fray Antonio Alcalde," Guadalajara, Mexico; and Instituto de Ciencias Neurologicas "Luis Trelles Montes" (M.V.), Lima, Peru.
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Kilbane C, Ramirez-Zamora A, Ryapolova-Webb E, Qasim S, Glass GA, Starr PA, Ostrem JL. Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases. J Neurosurg 2015; 122:1306-14. [DOI: 10.3171/2015.2.jns141098] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECT
Holmes tremor (HT) is characterized by irregular, low-frequency (< 4.5 Hz) tremor occurring at rest, with posture, and with certain actions, often affecting proximal muscles. Previous reports have tended to highlight the use of thalamic deep brain stimulation (DBS) in cases of medication-refractory HT. In this study, the authors report the clinical outcome and analysis of single-unit recordings in patients with medication-refractory HT treated with globus pallidus internus (GPi) DBS.
METHODS
The authors retrospectively reviewed the medical charts of 4 patients treated with pallidal DBS for medication-refractory HT at the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center. Clinical outcomes were measured at baseline and after surgery using an abbreviated motor-severity Fahn-Tolosa-Marin (FTM) tremor rating scale. Intraoperative microelectrode recordings were performed with patients in the awake state. The neurophysiological characteristics identified in HT were then also compared with characteristics previously described in Parkinson's disease (PD) studied at the authors' institution.
RESULTS
The mean percentage improvement in tremor motor severity was 78.87% (range 59.9%–94.4%) as measured using the FTM tremor rating scale, with an average length of follow-up of 33.75 months (range 18–52 months). Twenty-eight GPi neurons were recorded intraoperatively in the resting state and 13 of these were also recorded during contralateral voluntary arm movement. The mean firing rate at rest in HT was 56.2 ± 28.5 Hz, and 63.5 ± 19.4 Hz with action, much lower than the GPi recordings in PD. GPi unit oscillations of 2–8 Hz were prominent in both patients with HT and those with PD, but in HT, unlike PD, these oscillations were not suppressed by voluntary movement.
CONCLUSIONS
The efficacy of GPi DBS exceeded that reported in prior studies of ventrolateral thalamus DBS and suggest GPi may be a better target for treating HT. These clinical and neurophysiological findings help illuminate evolving models of HT and highlight the importance of cerebellar–basal ganglia interactions.
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Affiliation(s)
- Camilla Kilbane
- 1Department of Neurology, Stanford University Medical Center, Stanford;
| | | | | | - Salman Qasim
- 3Neurosurgery, University of California, San Francisco
| | - Graham A. Glass
- 4Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California; and
| | - Philip A. Starr
- 3Neurosurgery, University of California, San Francisco
- 4Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California; and
| | - Jill L. Ostrem
- Departments of 2Neurology and
- 4Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California; and
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21
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Deep brain stimulation of the globus pallidus internus or ventralis intermedius nucleus of thalamus for Holmes tremor. Neurosurg Rev 2015; 38:753-63. [DOI: 10.1007/s10143-015-0636-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 10/06/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
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22
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Kocabicak E, Temel Y, Höllig A, Falkenburger B, Tan SK. Current perspectives on deep brain stimulation for severe neurological and psychiatric disorders. Neuropsychiatr Dis Treat 2015; 11:1051-66. [PMID: 25914538 PMCID: PMC4399519 DOI: 10.2147/ndt.s46583] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) has become a well-accepted therapy to treat movement disorders, including Parkinson's disease, essential tremor, and dystonia. Long-term follow-up studies have demonstrated sustained improvement in motor symptoms and quality of life. DBS offers the opportunity to selectively modulate the targeted brain regions and related networks. Moreover, stimulation can be adjusted according to individual patients' demands, and stimulation is reversible. This has led to the introduction of DBS as a treatment for further neurological and psychiatric disorders and many clinical studies investigating the efficacy of stimulating various brain regions in order to alleviate severe neurological or psychiatric disorders including epilepsy, major depression, and obsessive-compulsive disorder. In this review, we provide an overview of accepted and experimental indications for DBS therapy and the corresponding anatomical targets.
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Affiliation(s)
- Ersoy Kocabicak
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands ; Department of Neuroscience, Maastricht University, Maastricht, the Netherlands ; Department of Neurosurgery, Ondokuz Mayıs University, Samsun, Turkey
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands ; Department of Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Anke Höllig
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | | | - Sonny Kh Tan
- Department of Neuroscience, Maastricht University, Maastricht, the Netherlands ; Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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23
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Li S, Zaninotto AL, Neville IS, Paiva WS, Nunn D, Fregni F. Clinical utility of brain stimulation modalities following traumatic brain injury: current evidence. Neuropsychiatr Dis Treat 2015; 11:1573-86. [PMID: 26170670 PMCID: PMC4494620 DOI: 10.2147/ndt.s65816] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Traumatic brain injury (TBI) remains the main cause of disability and a major public health problem worldwide. This review focuses on the neurophysiology of TBI, and the rationale and current state of evidence of clinical application of brain stimulation to promote TBI recovery, particularly on consciousness, cognitive function, motor impairments, and psychiatric conditions. We discuss the mechanisms of different brain stimulation techniques including major noninvasive and invasive stimulations. Thus far, most noninvasive brain stimulation interventions have been nontargeted and focused on the chronic phase of recovery after TBI. In the acute stages, there is limited available evidence of the efficacy and safety of brain stimulation to improve functional outcomes. Comparing the studies across different techniques, transcranial direct current stimulation is the intervention that currently has the higher number of properly designed clinical trials, though total number is still small. We recognize the need for larger studies with target neuroplasticity modulation to fully explore the benefits of brain stimulation to effect TBI recovery during different stages of recovery.
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Affiliation(s)
- Shasha Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China ; Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA, USA
| | - Ana Luiza Zaninotto
- Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA, USA ; Division of Psychology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Iuri Santana Neville
- Division of Neurosurgery, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Wellingson Silva Paiva
- Division of Neurosurgery, University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Danuza Nunn
- Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA, USA
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24
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Grabska N, Rudzińska M, Dec-Ćwiek M, Tutaj M, Pietraszko W, Michalski M, Szczudlik A. Deep brain stimulation in the treatment of Holmes tremor – A long-term case observation. Neurol Neurochir Pol 2014; 48:292-5. [DOI: 10.1016/j.pjnns.2014.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/13/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
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