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Onder H, Kocer B, Turan A, Comoglu S. Illustration of the Long-Term Efficacy of Deep Brain Stimulation of the Thalamic Ventral Intermediate Nucleus in a Patient with Holmes Tremor Secondary to Stroke. Mov Disord Clin Pract 2023; 10:1143-1145. [PMID: 37476324 PMCID: PMC10354610 DOI: 10.1002/mdc3.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Affiliation(s)
- Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research HospitalAnkaraTurkey
| | - Bilge Kocer
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research HospitalAnkaraTurkey
| | - Aynur Turan
- Radiology Clinic, Diskapi Yildirim Beyazit Training and Research HospitalAnkaraTurkey
| | - Selcuk Comoglu
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research HospitalAnkaraTurkey
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Pauly MG, Brüggemann N, Efthymiou S, Grözinger A, Diaw SH, Chelban V, Turchetti V, Vona B, Tadic V, Houlden H, Münchau A, Lohmann K. Not to Miss: Intronic Variants, Treatment, and Review of the Phenotypic Spectrum in VPS13D-Related Disorder. Int J Mol Sci 2023; 24:ijms24031874. [PMID: 36768210 PMCID: PMC9953040 DOI: 10.3390/ijms24031874] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
VPS13D is one of four human homologs of the vacuolar sorting protein 13 gene (VPS13). Biallelic pathogenic variants in the gene are associated with spastic ataxia or spastic paraplegia. Here, we report two patients with intronic pathogenic variants: one patient with early onset severe spastic ataxia and debilitating tremor, which is compound-heterozygous for a canonical (NM_018156.4: c.2237-1G > A) and a non-canonical (NM_018156.4: c.941+3G>A) splice site variant. The second patient carries the same non-canonical splice site variant in the homozygous state and is affected by late-onset spastic paraplegia. We confirmed altered splicing as a result of the intronic variants and demonstrated disturbed mitochondrial integrity. Notably, tremor in the first patient improved significantly by bilateral deep brain stimulation (DBS) in the ventralis intermedius (VIM) nucleus of the thalamus. We also conducted a literature review and summarized the phenotypical spectrum of reported VPS13D-related disorders. Our study underscores that looking for mutations outside the canonical splice sites is important not to miss a genetic diagnosis, especially in disorders with a highly heterogeneous presentation without specific red flags.
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Affiliation(s)
- Martje G. Pauly
- Institute of Neurogenetics, University of Lübeck, 23562 Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, 23562 Lübeck, Germany
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, 23562 Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, 23562 Lübeck, Germany
| | - Stephanie Efthymiou
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Anne Grözinger
- Institute of Neurogenetics, University of Lübeck, 23562 Lübeck, Germany
| | | | - Viorica Chelban
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Valentina Turchetti
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Barbara Vona
- Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, 37075 Göttingen, Germany
- Institute of Human Genetics, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Vera Tadic
- Institute of Neurogenetics, University of Lübeck, 23562 Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, 23562 Lübeck, Germany
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, 23562 Lübeck, Germany
- Correspondence:
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Oda K, Morishita T, Tanaka H, Kobayashi H, Abe H. Case report: Radiofrequency thalamotomy as palliative care for Holmes tremor in a patient with terminal cancer and cardiac pacemaker. Surg Neurol Int 2022; 13:484. [PMID: 36324913 PMCID: PMC9610373 DOI: 10.25259/sni_618_2022] [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: 07/11/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Herein, we present a case report of a patient with Holmes tremor due to thalamic infarction with end-stage pancreatic cancer who underwent successful computed tomography (CT)-guided ventralis intermedius nucleus (Vim) thalamotomy as palliative care. Case Description: A 78-year-old man with gradually worsening involuntary movements on the left side of his body 2 years after a right thalamic infarction was referred to our institute. He had a history of chronic atrial fibrillation for which he was implanted with a cardiac pacemaker not compatible with magnetic resonance imaging. He also received adjuvant therapy for pancreatic cancer. As the involuntary movements interfered with his daily life, the patient elected for neurosurgical treatment despite having terminal cancer. Although the prognosis for pancreatic cancer was considered to be more than 6 months at the time of surgery, we performed CT-guided Vim thalamotomy under local anesthesia without pulse generator implantation considering the patient’s general condition. The involuntary movements of the left side of the body reduced following surgery, thus improving his quality of life (QOL). However, 6 months after thalamotomy, the patient died of pancreatic cancer. Conclusion: Thalamotomy significantly reduced the involuntary movements immediately after the procedure. Therefore, thalamotomy can be performed under local anesthesia without the use of any device and may contribute to the improvement of QOL in terminal patients.
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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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Serhan A, Kiwan A, Abushukair H, Yassin A. Deep brain stimulation use in treating multiple sclerosis tremor: A practical approach for meta-analyses. Mult Scler Relat Disord 2022; 58:103491. [PMID: 35042091 DOI: 10.1016/j.msard.2022.103491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/27/2022]
Abstract
Deep brain stimulation (DBS) has been introduced as a treatment option for multiple sclerosis (MS) related tremor. Recent emerging studies have investigated its efficacy and safety, yet no study has systematically assessed the evidence on this topic. Zali and colleagues have conducted the first systematic review and meta-analysis on the use of DBS in MS tremor patients. In this letter, we highlight some points in their meta-analysis regarding high heterogeneity levels that reflect some methodological concerns related to pooling studies with considerable variability. We also suggest some approaches to address this problem.
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Affiliation(s)
- Abdullah Serhan
- Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan
| | - Ahmad Kiwan
- Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan
| | - Ahmed Yassin
- Department of Neurosciences, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan.
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Gadot R, Shofty B, Najera RA, Anand A, Banks G, Khan AB, LoPresti MA, Vanegas Arroyave N, Sheth SA. Case Report: Dual Target Deep Brain Stimulation With Externalized Programming for Post-traumatic Complex Movement Disorder. Front Neurosci 2021; 15:774073. [PMID: 34819837 PMCID: PMC8606815 DOI: 10.3389/fnins.2021.774073] [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: 09/10/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Movement disorders can be common, persistent, and debilitating sequelae of severe traumatic brain injury. Post-traumatic movement disorders are usually complex in nature, involving multiple phenomenological manifestations, and can be difficult to control with medical management alone. Deep brain stimulation (DBS) has been used to treat these challenging cases, but distorted brain anatomy secondary to trauma can complicate effective targeting. In such cases, use of diffusion tractography imaging and inpatient testing with externalized DBS leads can be beneficial in optimizing outcomes. Case Description: We present the case of a 42-year-old man with severe, disabling post-traumatic tremor who underwent bilateral, dual target DBS to the globus pallidus internus (GPi) and a combined ventral intermediate nucleus of the thalamus (Vim)/dentato-rubro-thalamic tracts (DRTT) target. DRTT fiber tracts were reconstructed preoperatively to assist in surgical targeting given the patient’s distorted anatomy. Externalization and survey of the four leads extra-operatively with inpatient testing allowed for internalization of the leads that demonstrated benefit. Six months after surgery, the patient’s tremor and dystonic burden had decreased by 67% in the performance sub-score of The Essential Tremor Rating Scale (TETRAS). Conclusion: A patient-tailored approach including target selection guided by individualized anatomy and tractography as well as extra-operative externalized lead interrogation was shown to be effective in optimizing clinical outcome in a patient with refractory post-traumatic tremor.
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Affiliation(s)
- Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Ricardo A Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Garrett Banks
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, United States
| | - Abdul Basit Khan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | | | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
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