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Yilmaz A, Eray HA, Cakir M, Ceylan M, Blomstedt P. Deep Brain Stimulation with Double Targeting of the VIM and PSA for the Treatment of Rare Tremor Syndromes. Stereotact Funct Neurosurg 2024; 102:224-239. [PMID: 38934181 DOI: 10.1159/000539162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/28/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION In tremor syndromes, pharmacological therapy is the primary treatment, but deep brain stimulation (DBS) is used when it is insufficient. We explore the use of DBS, focusing on the globus pallidus internus for dystonia and the ventral intermediate nucleus (VIM) for tremor conditions. We introduce the posterior subthalamic area (PSA) as a potential target, suggesting its efficacy in tremor reduction, particularly in rare tremor syndromes. We aim to evaluate the efficacy and safety of double targeting the VIM and PSA in rare tremor conditions, highlighting the limited existing data on this. METHODS Between 2019 and 2023, 22 patients with rare tremor syndromes were treated with bilateral DBS of the VIM and PSA. This case series consisted of 7 isolated head tremor, 1 hepatic encephalopathic tremor due to Abernethy syndrome, 2 voice tremor, 4 dystonic tremor, and 8 Holmes tremor (2 multiple sclerosis, 2 cerebellar insult, and 4 posttraumatic) patients. Patients' preoperative and 12-month postoperative tremor scores were compared, and the optimum VIM and PSA stimulation areas were investigated. RESULTS There was a significant reduction in the mean TRS score from 3.70 (±0.57) to 0.45 (±0.68) after 12 months of surgery. Specific outcomes for different indications were observed: for head tremor, 6 of 7 patients showed a reduction in TRS scores to 0 points; the vocal tremor patients demonstrated improvement; this change was not statistically significant, which is likely to be due to the low number of patients in this subgroup; the dystonic tremor patients showed either complete tremor abolition or a reduction in TRS scores; the Holmes tremor patients showed an 80% reduction in TRS scores; and the hepatic encephalopathy tremor and Abernethy syndrome patients showed a 75% improvement in TRS scores. The stimulation parameters converged on the VIM and dorsal PSA. Complications included the need for electrode repositioning, infections requiring electrode removal and re-implantation, dysarthria, and stimulation-induced ataxia, which was resolved by adjusting the stimulation parameters. DISCUSSION The literature on DBS for rare tremors is limited. Double targeting of the VIM and PSA appears to produce promising improvements on the outcomes reported in the existing literature on VIM-only DBS. The proximity of the VIM and PSA allows for flexible electrode placement, contributing to the potential success of the dual-target approach. We also discuss the theoretical advantages of targeting the PSA based on the distribution of tremor circuits, emphasizing the need for further research and electrophysiological studies.
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Affiliation(s)
- Atilla Yilmaz
- Department of Neurosurgery, Istanbul Health and Technology University, Istanbul, Turkey
| | - Halit Anıl Eray
- Ankara University School of Medicine, Department of Neurosurgery, Ankara, Turkey,
| | - Murtaza Cakir
- Ataturk University Faculty of Medicine, Department of Neurosurgery, Erzurum, Turkey
| | - Mustafa Ceylan
- Ataturk University Faculty of Medicine, Department of Neurology, Erzurum, Turkey
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Liu B, Xu J, Feng Z, Hui R, Zhang Y, Liu D, Chang Q, Yu X, Mao Z. One-pass deep brain stimulation of subthalamic nucleus and ventral intermediate nucleus for levodopa-resistant tremor-dominant Parkinson's disease. Front Aging Neurosci 2023; 15:1289183. [PMID: 38187361 PMCID: PMC10768017 DOI: 10.3389/fnagi.2023.1289183] [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: 09/05/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Tremor-dominant Parkinson's disease (TD-PD) can be further separated into levodopa-responsive and levodopa-resistant types, the latter being considered to have a different pathogenesis. Previous studies indicated that deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the globus pallidus internus (GPi) individually was not sufficient for tremor control, especially for the levodopa-resistant TD-PD (LRTD-PD). The thalamic ventral intermediate nucleus (VIM) has been regarded as a potent DBS target for different kinds of tremors. Therefore, we focused on the LRTD-PD subgroup and performed one-pass combined DBSs of STN and VIM to treat refractory tremors, aiming to investigate the safety and effectiveness of this one-trajectory dual-target DBS scheme. Methods We retrospectively collected five LRTD-PD patients who underwent a one-pass combined DBS of STN and VIM via a trans-frontal approach. The targeting of VIM was achieved by probabilistic tractography. Changes in severity of symptoms (measured by the Unified Parkinson Disease Rating Scale part III, UPDRS-III), levodopa equivalent daily doses (LEDD), and disease-specific quality of life (measured by the 39-item Parkinson's Disease Questionnaire, PDQ-39) were evaluated. Results Three-dimensional reconstruction of electrodes illustrated that all leads were successfully implanted into predefined positions. The mean improvement rates (%) were 53 ± 6.2 (UPDRS-III), 82.6 ± 11.4 (tremor-related items of UPDRS), and 52.1 ± 11.4 (PDQ-39), respectively, with a mean follow-up of 11.4 months. Conclusion One-pass combined DBS of STN and VIM via the trans-frontal approach is an effective and safe strategy to alleviate symptoms for LRTD-PD patients.
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Affiliation(s)
- Bin Liu
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junpeng Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhebin Feng
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rui Hui
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanyang Zhang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Di Liu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qing Chang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Paro MR, Dyrda M, Ramanan S, Wadman G, Burke SA, Cipollone I, Bosworth C, Zurek S, Senatus PB. Deep brain stimulation for movement disorders after stroke: a systematic review of the literature. J Neurosurg 2023; 138:1688-1701. [PMID: 36308482 DOI: 10.3171/2022.8.jns221334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stroke remains the leading cause of disability in the United States. Even as acute care for strokes advances, there are limited options for improving function once the patient reaches the subacute and chronic stages. Identification of new therapeutic approaches is critical. Deep brain stimulation (DBS) holds promise for these patients. A number of case reports and small case series have reported improvement in movement disorders after strokes in patients treated with DBS. In this systematic review, the authors have summarized the patient characteristics, anatomical targets, stimulation parameters, and outcomes of patients who have undergone DBS treatment for poststroke movement disorders. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The PubMed, Scopus, and SpringerLink databases were searched for the keywords "DBS," "stroke," "movement," and "recovery" to identify patients treated with DBS for movement disorders after a stroke. The Joanna Briggs Institute Critical Appraisal checklists for case reports and case series were used to systematically analyze the quality of the included studies. Data collected from each study included patient demographic characteristics, stroke diagnosis, movement disorder, DBS target, stimulation parameters, complications, and outcomes. RESULTS The authors included 29 studies that described 53 patients who underwent placement of 82 total electrodes. Movement disorders included tremor (n = 18), dystonia (n = 18), hemiballism (n = 6), spastic hemiparesis (n = 1), chorea (n = 1), and mixed disorders (n = 9). The most common DBS targets were the globus pallidus internus (n = 32), ventral intermediate nucleus of thalamus (n = 25), and subthalamic area/subthalamic nucleus (n = 7). Monopolar stimulation was reported in 43 leads and bipolar stimulation in 13. High-frequency stimulation was used in 57 leads and low-frequency stimulation in 6. All patients but 1 had improvement in their movement disorders. Two complications were reported: speech impairment in 1 patient and hardware infection in another. The median (interquartile range) duration between stroke and DBS treatment was 6.5 (2.1-15.8) years. CONCLUSIONS This is the first systematic review of DBS for poststroke movement disorders. Overall, most studies to date have been case reports and small series reporting heterogeneous patients and surgical strategies. This review suggests that DBS for movement disorders after a stroke has the potential to be effective and safe for diverse patients, and DBS may be a feasible option to improve function even years after a stroke.
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Affiliation(s)
- Mitch R Paro
- 1University of Connecticut School of Medicine, Farmington
| | - Michal Dyrda
- 1University of Connecticut School of Medicine, Farmington
| | | | | | | | | | - Cory Bosworth
- 3Deep Brain Stimulation Program, Ayer Neuroscience Institute, Hartford Hospital, Hartford; and
| | - Sarah Zurek
- 3Deep Brain Stimulation Program, Ayer Neuroscience Institute, Hartford Hospital, Hartford; and
| | - Patrick B Senatus
- 3Deep Brain Stimulation Program, Ayer Neuroscience Institute, Hartford Hospital, Hartford; and
- 4Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut
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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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Maesawa S, Torii J, Nakatsubo D, Noda H, Mutoh M, Ito Y, Ishizaki T, Tsuboi T, Suzuki M, Tanei T, Katsuno M, Saito R. A case report: Dual-lead deep brain stimulation of the posterior subthalamic area and the thalamus was effective for Holmes tremor after unsuccessful focused ultrasound thalamotomy. Front Hum Neurosci 2022; 16:1065459. [PMID: 36590066 PMCID: PMC9798537 DOI: 10.3389/fnhum.2022.1065459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Holmes tremor is a symptomatic tremor that develops secondary to central nervous system disorders. Stereotactic neuromodulation is considered when the tremors are intractable. Targeting the ventral intermediate nucleus (Vim) is common; however, the outcome is often unsatisfactory, and the posterior subthalamic area (PSA) is expected as alternative target. In this study, we report the case of a patient with intractable Holmes tremor who underwent dual-lead deep brain stimulation (DBS) to stimulate multiple locations in the PSA and thalamus. The patient was a 77-year-old female who complained of severe tremor in her left upper extremity that developed one year after her right thalamic infarction. Vim-thalamotomy using focused ultrasound therapy (FUS) was initially performed but failed to control tremor. Subsequently, we performed DBS using two leads to stimulate four different structures. Accordingly, one lead was implanted with the aim of targeting the ventral oralis nucleus (Vo)/zona incerta (Zi), and the other with the aim of targeting the Vim/prelemniscal radiation (Raprl). Electrode stimulation revealed that Raprl and Zi had obvious effects. Postoperatively, the patient achieved good tremor control without any side effects, which was maintained for two years. Considering that she demonstrated resting, postural, and intention/action tremor, and Vim-thalamotomy by FUS was insufficient for tremor control, complicated pathogenesis was presumed in her symptoms including both the cerebellothalamic and the pallidothalamic pathways. Using the dual-lead DBS technique, we have more choices to adjust the stimulation at multiple sites, where different functional networks are connected. Intractable tremors, such as Holmes tremor, may have complicated pathology, therefore, modulating multiple pathological networks is necessary. We suggest that the dual-lead DBS (Vo/Raprl and Vim/Zi) presented here is safe, technically feasible, and possibly effective for the control of Holmes tremor.
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Affiliation(s)
- Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan,*Correspondence: Satoshi Maesawa ✉
| | - Jun Torii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Nakatsubo
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan,The Center for Focused Ultrasound Therapy, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Hiroshi Noda
- Department of Neurosurgery, Iwakura Hospital, Iwakura, Japan
| | - Manabu Mutoh
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Ito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomotaka Ishizaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yousefi O, Dayyani M, Rezaei R, Kamran H, Razmkon A. Deep brain stimulation of the posterior subthalamic area as an alternative strategy for management of Holmes tremor: A case report and review of the literature. Surg Neurol Int 2022; 13:489. [DOI: 10.25259/sni_435_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Holmes tremor is often refractory to medical treatment and deep brain stimulation of the ventralis intermedius nucleus of the thalamus (VIM-DBS) is the intervention of choice in controlling the tremor. Herein, we present a beneficial alternative strategy for the management of such situations, considering the posterior subthalamic area (PSA) as the target of stimulation.
Case Description:
We report a 57-year-old male with the right-sided tremor following a traumatic brain injury 20 years ago. He had been diagnosed with Holmes tremor that was not responsive to nonsurgical therapeutic options. When refractoriness confirmed, he became a candidate for VIM-DBS. During the operation, by performing macrostimulation with a maximum of 2 mA of amplitude, the tremor had no response to the stimulation of different tracts, and severe right hemi-body paresthesia occurred; therefore, we modified our approach and targeted the PSA, which resulted in satisfactory control of the tremor. The permanent lead was implanted into the left side PSA. At 1-year follow-up, the right side tremor was under complete control.
Conclusion:
Our case and other similar pieces of evidence are consistently indicating the potential regulatory effects of PSA-DBS in controlling the Holmes tremor as a feasible alternative strategy when VIM-DBS does not provide a satisfactory response. However, further studies with larger sample size are required to evaluate the long-term response and its possible long-term stimulation-related effects.
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Affiliation(s)
- Omid Yousefi
- Department of Neurosurgery, Neuromapc, Shiraz, Iran,
| | - Mojtaba Dayyani
- Division of Neurosurgery, City of Hope Beckman Research Institute and Medical Center, Duarte, California, United States
| | - Razieh Rezaei
- Department of Neurosurgery, Neuromapc, Shiraz, Iran,
| | - Hooman Kamran
- Department of Neurosurgery, Neuromapc, Shiraz, Iran,
| | - Ali Razmkon
- Department of Neurosurgery, Neuromapc, Shiraz, Iran,
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Pyrgelis ES, Agapiou E, Angelopoulou E. Holmes tremor: an updated review. Neurol Sci 2022; 43:6731-6740. [DOI: 10.1007/s10072-022-06352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
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Mendonça M, Cotovio G, Barbosa R, Grunho M, Oliveira-Maia AJ. An Argument in Favor of Deep Brain Stimulation for Uncommon Movement Disorders: The Case for N-of-1 Trials in Holmes Tremor. Front Hum Neurosci 2022; 16:921523. [PMID: 35782038 PMCID: PMC9247189 DOI: 10.3389/fnhum.2022.921523] [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: 04/16/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) is part of state-of-the-art treatment for medically refractory Parkinson’s disease, essential tremor or primary dystonia. However, there are multiple movement disorders that present after a static brain lesion and that are frequently refractory to medical treatment. Using Holmes tremor (HT) as an example, we discuss the effectiveness of currently available treatments and, performing simulations using a Markov Chain approach, propose that DBS with iterative parameter optimization is expected to be more effective than an approach based on sequential trials of pharmacological agents. Since, in DBS studies for HT, the thalamus is a frequently chosen target, using data from previous studies of lesion connectivity mapping in HT, we compared the connectivity of thalamic and non-thalamic targets with a proxy of the HT network, and found a significantly higher connectivity of thalamic DBS targets in HT. The understanding of brain networks provided by analysis of functional connectivity may thus provide an informed framework for proper surgical targeting of individual patients. Based on these findings, we argue that there is an ethical imperative to at least consider surgical options in patients with uncommon movement disorders, while simultaneously providing consistent information regarding the expected effectiveness and risks, even in a scenario of surgical-risk aversion. An approach based on n-of-1 DBS trials may ultimately significantly improve outcomes while informing on optimal therapeutic targets and parameter settings for HT and other disabling and rare movement disorders.
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Affiliation(s)
- Marcelo Mendonça
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- *Correspondence: Marcelo Mendonça,
| | - Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Raquel Barbosa
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Department of Neurology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Grunho
- Department of Neurology, Hospital Garcia de Orta, Almada, Portugal
| | - Albino J. Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Albino J. Oliveira-Maia,
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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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Azghadi A, Rajagopal MM, Atkinson KA, Holloway KL. Utility of GPI+VIM dual-lead deep brain stimulation for Parkinson's disease patients with significant residual tremor on medication. J Neurosurg 2022; 136:1364-1370. [PMID: 34598140 DOI: 10.3171/2021.4.jns21502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Randomized controlled trials have demonstrated that deep brain stimulation (DBS) of both the globus pallidus internus (GPI) and subthalamic nucleus (STN) for Parkinson's disease (PD) is superior to the best medical therapy. Tremor is particularly responsive to DBS, with reports of 70%-80% improvement. However, a small number of patients do not obtain the expected response with both STN and GPI targets. Indeed, the authors' patient population had a similar 81.2% tremor reduction with a 9.6% failure rate. In an analysis of these failures, they identified patients with preoperative on-medication tremor who subsequently received a GPI lead as a subpopulation at higher risk for inadequate tremor control. Thereafter, STN DBS was recommended for patients with on-medication tremor. However, for the patients with symptoms and comorbidities that favored GPI as the target, dual GPI and ventral intermediate nucleus of the thalamus (VIM) leads were proposed. This report details outcomes for those patients. METHODS This is a retrospective review of patients with PD who met the criteria for and underwent simultaneous GPI+VIM DBS surgery from 2015 to 2020 and had available follow-up data. The preoperative Unified Parkinson's Disease Rating Scale scores were obtained with the study participants on and off their medication. Postoperatively, the GPI lead was kept on at baseline and scores were obtained with and without VIM stimulation. RESULTS Thirteen PD patients with significant residual preoperative tremor on medication underwent simultaneous GPI+VIM DBS surgery (11 unilateral, 2 bilateral). A mean 90.6% (SD 15.0%) reduction in tremor scores was achieved with dual GPI+VIM stimulation compared to a 21.8% (SD 71.9%) reduction with GPI stimulation alone and a 30.9% (SD 37.8%) reduction with medication. Although rigidity and bradykinesia reductions were accomplished with just GPI stimulation, 13 of the 15 hemispheres required VIM stimulation to achieve excellent tremor control. CONCLUSIONS GPI+VIM stimulation was required to adequately control tremor in all but 2 patients in this series, substantiating the authors' hypothesis that, in their population, medication-resistant tremor does not completely respond to GPI stimulation. Dual stimulation of the GPI and VIM proved to be an effective option for the patients who had symptoms and comorbidities that favored GPI as a target and had medication-resistant tremor.
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Affiliation(s)
- Adel Azghadi
- 1School of Medicine, Virginia Commonwealth University, Richmond
| | - Megan M Rajagopal
- 2Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and
| | - Kelsey A Atkinson
- 2Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and
| | - Kathryn L Holloway
- 2Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and
- 3Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
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Sugiyama J, Toda H. A Single DBS-Lead to Stimulate the Thalamus and Subthalamus: Two-Story Targets for Tremor Disorders. Front Hum Neurosci 2022; 16:790942. [PMID: 35140594 PMCID: PMC8820320 DOI: 10.3389/fnhum.2022.790942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
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Parker T, Raghu ALB, FitzGerald JJ, Green AL, Aziz TZ. Multitarget deep brain stimulation for clinically complex movement disorders. J Neurosurg 2021; 134:351-356. [PMID: 31899879 DOI: 10.3171/2019.11.jns192224] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/01/2019] [Indexed: 11/06/2022]
Abstract
Deep brain stimulation (DBS) of single-target nuclei has produced remarkable functional outcomes in a number of movement disorders such as Parkinson's disease, essential tremor, and dystonia. While these benefits are well established, DBS efficacy and strategy for unusual, unclassified movement disorder syndromes is less clear. A strategy of dual pallidal and thalamic electrode placement is a rational approach in such cases where there is profound, medically refractory functional impairment. The authors report a series of such cases: midbrain cavernoma hemorrhage with olivary hypertrophy, spinocerebellar ataxia-like disorder of probable genetic origin, Holmes tremor secondary to brainstem stroke, and hemiballismus due to traumatic thalamic hemorrhage, all treated by dual pallidal and thalamic DBS. All patients demonstrated robust benefit from DBS, maintained in long-term follow-up. This series demonstrates the flexibility and efficacy, but also the limitations, of dual thalamo-pallidal stimulation for managing axial and limb symptoms of tremors, dystonia, chorea, and hemiballismus in patients with complex movement disorders.
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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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NAKAJIMA Y, KAMBE D, TODA H, NISHIDA N, NAGAO S, SAWAMOTO N, OKUMURA R, OZAKI A, IWASAKI K. Thalamic Deep Brain Stimulation for Refractory Atypical Tremor after Encephalitis of Unknown Etiology: A Case Report. NMC Case Rep J 2021; 8:247-252. [PMID: 35079471 PMCID: PMC8769394 DOI: 10.2176/nmccrj.cr.2020-0245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
Tremor associated with encephalitis is usually transient and rarely becomes chronic and refractory. Treatment for such tremor using deep brain stimulation (DBS) has not yet been reported. We report an uncommon case of chronic tremor after encephalitis of unknown etiology and its outcome treated with thalamic DBS. A 47-year-old man presented with a 6-month history of medically refractory tremor after non-infectious and probable autoimmune encephalitis. The patient showed an atypical mixture of resting, postural, kinetic, and intention tremor. The tremor significantly disabled the patient’s activities of daily life (ADL). The patient underwent bilateral thalamic DBS surgery. DBS leads were placed to cross the border between the ventralis oralis posterior (Vop) nucleus and ventralis intermedius (Vim) nucleus of the thalamus. Stimulation of both the Vop and Vim using the bipolar contacts controlled the mixed occurrence of tremor. The ADL and performance scores on The Essential Tremor Rating Assessment Scale (TETRAS) improved from 47 to 0 and from 44 to 9, respectively. The therapeutic effects have lasted for 24 months. Administration of combined Vop and Vim DBS may control uncommon tremor of atypical etiology and phenomenology.
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Affiliation(s)
- Yusuke NAKAJIMA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
| | - Daisuke KAMBE
- Department of Neurology, Kyoto University, Kyoto, Kyoto, Japan
| | - Hiroki TODA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui, Fukui, Japan
| | - Namiko NISHIDA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
| | - Shigeto NAGAO
- Department of Neurology, Saiseikai-Nakatsu Hospital, Osaka, Osaka, Japan
| | | | - Ryosuke OKUMURA
- Department of Radiology, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
| | - Akihiko OZAKI
- Department of Neurology, Saiseikai-Nakatsu Hospital, Osaka, Osaka, Japan
| | - Koichi IWASAKI
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
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15
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Iorio-Morin C, Fomenko A, Kalia SK. Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes. Brain Sci 2020; 10:E925. [PMID: 33271848 PMCID: PMC7761254 DOI: 10.3390/brainsci10120925] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Tremor is a prevalent symptom associated with multiple conditions, including essential tremor (ET), Parkinson's disease (PD), multiple sclerosis (MS), stroke and trauma. The surgical management of tremor evolved from stereotactic lesions to deep-brain stimulation (DBS), which allowed safe and reversible interference with specific neural networks. This paper reviews the current literature on DBS for tremor, starting with a detailed discussion of current tremor targets (ventral intermediate nucleus of the thalamus (Vim), prelemniscal radiations (Raprl), caudal zona incerta (Zi), thalamus (Vo) and subthalamic nucleus (STN)) and continuing with a discussion of results obtained when performing DBS in the various aforementioned tremor syndromes. Future directions for DBS research are then briefly discussed.
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Affiliation(s)
- Christian Iorio-Morin
- Christian Iorio-Morin, Division of Neurosurgery, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (A.F.); (S.K.K.)
| | - Anton Fomenko
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (A.F.); (S.K.K.)
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (A.F.); (S.K.K.)
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16
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Macerollo A, Hammersley B, Bonello M, Somerset J, Bhargava D, Das K, Osman-Farah J, Eldridge PR, Alusi SH. Deep brain stimulation for post-thalamic stroke complex movement disorders. Neurol Sci 2020; 42:337-342. [PMID: 32654009 DOI: 10.1007/s10072-020-04572-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Macerollo
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK. .,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - B Hammersley
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - M Bonello
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - J Somerset
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - D Bhargava
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - K Das
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - J Osman-Farah
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - P R Eldridge
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - S H Alusi
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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17
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Wang KL, Wong JK, Eisinger RS, Carbunaru S, Smith C, Hu W, Shukla AW, Hess CW, Okun MS, Ramirez-Zamora A. Therapeutic Advances in the Treatment of Holmes Tremor: Systematic Review. Neuromodulation 2020; 25:796-803. [PMID: 32578304 DOI: 10.1111/ner.13220] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/22/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to formulate a practical clinical treatment algorithm for Holmes's tremor (HT) by reviewing currently published clinical data. MATERIALS AND METHODS We performed a systematic review of articles discussing the management of HT published between January 1990 and December 2018. We examined data from 89 patients published across 58 studies detailing the effects of pharmacological or surgical interventions on HT severity. Clinical outcomes were measured by a continuous 1-10 ranked scale. The majority of studies addressing treatment response were case series or case reports. No randomized control studies were identified. RESULTS Our review included 24 studies focusing on pharmacologic treatments of 25 HT patients and 34 studies focusing on the effect of deep brain stimulation (DBS) in 64 patients. In the medical intervention group, the most commonly used drugs were levetiracetam, trihexyphenidyl, and levodopa. In the surgically treated group, the thalamic ventralis intermedius nucleus (VIM) and globus pallidus internus (GPi) were the most common brain targets for neuromodulation. The two targets accounted for 57.8% and 32.8% of total cases, respectively. Overall, compared to the medically treated group, DBS provided greater tremor suppression (p = 0.025) and was more effective for the management of postural tremor in HT. Moreover, GPi DBS displayed greater benefit in the resting tremor component (p = 0.042) and overall tremor reduction (p = 0.022). CONCLUSIONS There is a highly variable response to different medical treatments in HT without randomized clinical trials available to dictate treatment decisions. A variety of medical and surgical treatment options can be considered for the management of HT. Collaborative reseach between different institutions and researchers are warranted and needed to improve our understanding of the pathophysiology and management of this condition. In this review, we propose a practical treatment algorithm for HT based on currently available evidence.
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Affiliation(s)
- Kai-Liang Wang
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Joshua K Wong
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Samuel Carbunaru
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christine Smith
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Wei Hu
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Christopher W Hess
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Program for Movement Disorders and Neurorestoration, Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, FL, USA.
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18
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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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19
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Dec-Ćwiek M, Tutaj M, Pietraszko W, Libionka W, Krupa M, Moskała M, Rudzińska-Bar M, Słowik A, Pera J. Posterior Subthalamic Area Deep Brain Stimulation for Treatment of Refractory Holmes Tremor. Stereotact Funct Neurosurg 2019; 97:183-188. [DOI: 10.1159/000502563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 08/08/2019] [Indexed: 11/19/2022]
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20
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Kreisler A, Bouchain B, Defebvre L, Krystkowiak P. Treatment with Botulinum Neurotoxin Improves Activities of Daily Living and Quality of Life in Patients with Upper Limb Tremor. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-640. [PMID: 31413896 PMCID: PMC6691906 DOI: 10.7916/tohm.v0.640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/14/2019] [Indexed: 01/30/2023]
Abstract
Background Botulinum neurotoxin’s degree of effectiveness on upper limb tremor is subject to debate; although this treatment reduces the tremor’s amplitude, a clear functional benefit has not been demonstrated. The objective of this study was to assess the effect of botulinum neurotoxin type A treatment on activities of daily living and quality of life in patients with upper limb tremor. Methods We retrospectively examined the medical records of 50 consecutive patients treated with botulinum neurotoxin for upper limb tremor that was refractory to oral medication. One month after the injection, the patient was evaluated according to the Quality of Life in Essential Tremor Questionnaire, and the Essential Tremor Embarrassment Assessment. Results Full data sets were available for 38 patients suffering variously from essential tremor (n = 21), Holmes tremor secondary to a focal brain lesion (n = 8), idiopathic dystonic tremor (n = 4), primary writing tremor (n = 4), and Parkinson’s disease (n = 1). The Quality of Life Essential Tremor Questionnaire and the Essential Tremor Embarrassment Assessment scores improved significantly (p < 0.001) in the study population as a whole, and in the essential tremor and Holmes tremor subgroups. Discussion Botulinum neurotoxin treatment of patients with upper limb tremor is associated with improved quality of life and activities of daily living, irrespective of the tremor’s etiology. Long-term treatment enables the physician to adjust the injection strategy to the patient’s needs. Our study was limited by its retrospective design. The results must therefore be confirmed in a prospective, double-blind, placebo-controlled, randomized clinical trial.
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Affiliation(s)
| | | | - Luc Defebvre
- Neurologie et Pathologie du Mouvement, CHU Lille, Lille, FR
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21
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Yuk CD, Ahn JH, Oh JK, Chang IB, Song JH, Kim JH. Deep brain stimulation of the ventralis intermedius nucleus of the thalamus and posterior subthalamic area for Holmes' tremor secondary to brainstem hemorrhage: A case report. J Clin Neurosci 2018; 60:160-164. [PMID: 30340967 DOI: 10.1016/j.jocn.2018.10.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/06/2018] [Indexed: 11/28/2022]
Abstract
Holmes' tremor is a rare but severely disabling movement disorder characterized by a combination of resting, action, and intention tremor. Because Holmes' tremor is usually resistant to pharmacotherapy, surgical treatment is required for symptom control in most cases. We report the case of a 56-year-old man who was diagnosed with Holmes' tremor and treated with stimulation of the ventralis intermedius nucleus of the thalamus and posterior subthalamic area. Deep brain stimulation alleviated the patient's tremor over a 3-year follow-up period.
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Affiliation(s)
- Chang Duk Yuk
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - In Bok Chang
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Kangwon National University College of Medicine, Chuncheon, Republic of Korea.
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22
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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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23
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Budman E, Deeb W, Martinez-Ramirez D, Pilitsis JG, Peng-Chen Z, Okun MS, Ramirez-Zamora A. Potential indications for deep brain stimulation in neurological disorders: an evolving field. Eur J Neurol 2018; 25:434-e30. [PMID: 29266596 DOI: 10.1111/ene.13548] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022]
Abstract
Deep brain stimulation (DBS) is an established therapy for appropriately selected patients with movement disorders and neuropsychiatric conditions. Although the exact mechanisms and biology of DBS are not fully understood, it is a safe and well-tolerated therapy for many refractory cases of neuropsychiatric disease. Increasingly, DBS has been explored in other conditions with encouraging results. In this paper, available data is reviewed and new DBS targets, challenges and future directions in neurological disorders are explored. A detailed search of the medical literature discussing the potential use of DBS for neurological disorders excluding accepted indications was conducted. All reports were analyzed individually for content and redundant articles were excluded by examining individual abstracts. The level of evidence for each indication was summarized. Multiple studies report promising preliminary data regarding the safety and efficacy of DBS for a variety of neurological indications including chronic pain, tinnitus, epilepsy, Tourette syndrome, Huntington's disease, tardive dyskinesia and Alzheimer's disease. The initial results of DBS studies for diverse neurological disorders are encouraging but larger, controlled, prospective, homogeneous clinical trials are necessary to establish long-term safety and effectiveness. The field of neuromodulation continues to evolve and advances in DBS technology, stereotactic techniques, neuroimaging and DBS programming capabilities are shaping the present and future of DBS research and use in practice.
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Affiliation(s)
- E Budman
- Department of Neurology, Albany Medical College, Albany, NY, USA
| | - W Deeb
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - D Martinez-Ramirez
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - J G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Z Peng-Chen
- Unidad de Neurología, Hospital Padre Hurtado, Santiago, Chile.,Unidad Movimientos Anormales, Centro Medico Clínica Dávila, Santiago, Chile
| | - M S Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
| | - A Ramirez-Zamora
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, USA
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24
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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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Abstract
Tremor is a phenomenon observed in a broad spectrum of diseases with different pathophysiologies. While patients with tremor may not complain in the clinic of symptoms of imbalance, gait difficulties, or falls, laboratory research studies using quantitative analysis of gait and posture and neurophysiologic techniques have demonstrated impaired gait and balance across a variety of tremor etiologies. These findings have been supported by careful epidemiologic studies assessing symptoms of imbalance. Imaging and neurophysiologic studies have identified cerebellar networks as important mediators of tremor, and therefore a likely common site of dysfunction to explain the phenomenologic overlap between impaired postural and gait control with tremor. Further understanding of these mechanisms and networks is of crucial importance in the development of new treatments, particularly surgical or minimally invasive lesional therapies.
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Affiliation(s)
- Hugo Morales-Briceño
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Alessandro F Fois
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Hollingworth M, Sims-Williams HP, Pickering AE, Barua N, Patel NK. Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature. Brain Sci 2017; 7:brainsci7010009. [PMID: 28098766 PMCID: PMC5297298 DOI: 10.3390/brainsci7010009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 01/02/2023] Open
Abstract
Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies.
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Affiliation(s)
- Milo Hollingworth
- Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK.
| | | | - Anthony E Pickering
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol BS8 1TD, UK.
| | - Neil Barua
- Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK.
| | - Nikunj K Patel
- Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK.
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Ramirez-Zamora A, Smith H, Kumar V, Prusik J, Phookan S, Pilitsis JG. Evolving Concepts in Posterior Subthalamic Area Deep Brain Stimulation for Treatment of Tremor: Surgical Neuroanatomy and Practical Considerations. Stereotact Funct Neurosurg 2016; 94:283-297. [DOI: 10.1159/000449007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
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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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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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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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Fasano A, Deuschl G. Therapeutic advances in tremor. Mov Disord 2015; 30:1557-65. [DOI: 10.1002/mds.26383] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/29/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital-UHN, Division of Neurology, University of Toronto; Toronto Ontario Canada
| | - Günther Deuschl
- Department of Neurology; Christian-Albrechts-University Kiel; Germany
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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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Kim MK, Cho BM, Park SH, Yoon DY. Holmes' tremor associated with bilateral hypertrophic olivary degeneration following brain stem hemorrhage: a case report. J Cerebrovasc Endovasc Neurosurg 2014; 16:299-302. [PMID: 25340035 PMCID: PMC4205259 DOI: 10.7461/jcen.2014.16.3.299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 09/11/2014] [Accepted: 09/18/2014] [Indexed: 11/23/2022] Open
Abstract
Holmes' tremor is a condition characterized by a mixture of postural, rest, and action tremors due to midbrain lesions in the vicinity of the red nucleus. Hypertrophic olivary degeneration (HOD) is a rare type of neuronal degeneration involving the dento-rubro-olivary pathway and may present clinically as Holmes tremor. We report on a 59-year-old female patient who developed Holmes tremor in association with bilateral HOD, following brain stem hemorrhage.
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Affiliation(s)
- Min Kyu Kim
- Department of neurosurgery, Hallym University Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Byung Moon Cho
- Department of neurosurgery, Hallym University Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Se-Hyuck Park
- Department of neurosurgery, Hallym University Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Dae Young Yoon
- Department of Radiology, Hallym University Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
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