Bilateral thalamic stimulation for Holmes' tremor caused by unilateral brainstem lesion

Pallidal stimulation for Holmes tremor: clinical outcomes and single-unit recordings in 4 cases

“…Thalamic and dorsal or posterior STN DBS has been described in multiple case reports in patients with HT secondary to pontomesencephalic lesions with variable short-term results. 4,[9][10][11]25,27,29,30,33,34,[37][38][39][40]43,49,50 Recently Kobayashi et al reported 2-year outcome with dual thalamic and subthalamic area stimulation in 4 patients with HT, with significant benefit.…”

Letter to the Editor: Is one large target better than two?

“…In our series, 1 GPi target was better than 2 and resulted in greater clinical efficacy than most others have shown using single VIM or dual VIM, VO anterior, or VO posterior leads. 1,[3][4][5] Dr. Morishita and colleagues suggest that implanting rescue leads can be less precise and may help explain poor outcomes; however, in our series, a single GPi lead produced substantial benefit in 3 patients and did not require the placement of rescue leads. One lead is certainly better than 2 if that is all that is required, but we agree that it would be very helpful to be able to identify which type of HT patients might benefit from various target choices using imaging or physiological biomarkers rather than relying purely on phenotype.…”

“…5 I also discussed in another publication the use and advantages of a transfalcine approach for a contralateral hemispheric arteriovenous malformation. [2][3][4] The authors have erroneously mentioned that my technical description included only a frontal brain tumor. 1 The article and commentary by Dr. Heros with the response by Dr. Cohen-Gadol summarize the various positive and negative issues about the approach.…”

Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions

“…In selected cases DBS and thermocoagulation may offer an alternative therapeutic strategy. 1,8,15,16,21,23,27 Kim, et al, 15 reported on a 26-year-old man in whom unilateral Vim thalamotomy almost completely abolished Holmes tremor that had been caused by a midbrain tumor. Two additional case reports of patients with a midbrain cavernous angioma 16,23 document good to excellent clinical improvements in Holmes tremor following thalamic Vim stimulation.…”

“…7,10,17,18 On the contrary, in individual cases, stereotactic thalamotomy, 15 pallidotomy, 19 and thalamic DBS 16,26 have been reported to alleviate Holmes tremor. Note that following DBS, clinical improvements can occur in associated dystonia and rigidity as well as tremor, as demonstrated in this study and not described previously.…”