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

Abstract

<jats:p>✓Holmes tremor is caused by structural lesions in the perirubral area of the midbrain. Patients often present with associated symptoms such as dystonia and paresis, which are usually refractory to medical therapy. Here, the authors describe two patients in whom both tremor and associated dystonia improved markedly following unilateral stimulation of the thalamic nucleus ventralis intermedius.</jats:p>

The clinical and neuroimaging studies in Holmes tremor

“…published case reports where succesful HT treatment with non‐dopaminergic medication‐ levetiracetam was shown (2, 17). In cases refractory to pharmacological treatment the unilateral stereotactic surgery with thalamotomy or deep brain stimulation of ventralis intermedius (VIM) thalamic nucleus may be offered as an effective therapy (6, 18–21).…”

Deep Brain Stimulation for Dystonia: A Meta-Analysis

“…There are many reports in the literature of these surgeries, with case numbers ranging from 1 to 65; however, the majority are single case reports and small series (1–53). The etiologies of dystonia treated were quite varied, as were the surgical methods employed.…”

“…Table 1 delineates how this score is derived. Studies that did not report individual outcome data in the form of a BFM score were excluded, therefore, from statistical analyses (25–53).…”

Treatment of Wilson's disease motor complications with deep brain stimulation

“…Even though targeting of the thalamus for tremor caused by PD has been markedly reduced by the selection of additional targets for treatment of PD, Vim DBS has become a standard treatment for medically refractory ET . Moreover, this approach has been effectively used for other types of tremor, including a posttraumatic tremor, Holme's cerebellar tremor, and tremor caused by multiple sclerosis (MS) . Vim DBS surgery can be performed as either bilateral or unilateral procedures based on the degree of tremor affecting each upper extremity .…”