scholarly journals Letter: Thalamotomy-Like Effects From Partial Removal of a Ventral Intermediate Nucleus Deep Brain Stimulator Lead in a Patient With Essential Tremor: Case Report

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. E254-E255
Author(s):  
Rosario Maugeri ◽  
Angelo Franzini ◽  
Antonella Giugno ◽  
Domenico Gerardo Iacopino
Keyword(s):  
Case Report ◽  
Essential Tremor ◽  
Partial Removal ◽  
Deep Brain Stimulator ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

scholarly journals Thalamotomy-Like Effects From Partial Removal of a Ventral Intermediate Nucleus Deep Brain Stimulator Lead in a Patient With Essential Tremor

Neurosurgery ◽  
2015 ◽  
Vol 77 (5) ◽  
pp. E831-E837 ◽  
Author(s):  
John D. Rolston ◽  
Alexander D. Ramos ◽  
Susan Heath ◽  
Dario J. Englot ◽  
Daniel A. Lim
Keyword(s):  
Essential Tremor ◽  
High Frequency ◽  
Cerebral Injury ◽  
Zona Incerta ◽  
High Frequency Stimulation ◽  
Partial Removal ◽  
Complete Control ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

Abstract BACKGROUND AND IMPORTANCE: The ventral intermediate nucleus of the thalamus is a primary target of deep brain stimulation (DBS) in patients with essential tremor. Despite reliable control of contralateral tremor, there is sometimes a need for lead revision in cases of infection, hardware malfunction, or failure to relieve symptoms. Here, we present the case of a patient undergoing revision after ventral intermediate nucleus (Vim) DBS failed to control his tremor. During the electrode removal, the distal portion of the lead was found to be tightly adherent to tissue within the deep brain. Partial removal of the electrode in turn caused weakness, paresthesias, and tremor control similar to the effects produced by thalamotomy or thalamic injury. CLINICAL PRESENTATION: A 48-year-old man with essential tremor had bilateral Vim DBS leads implanted 10 years earlier but had poor control of his tremor and ultimately opted for surgical revision with lead placement in the zona incerta. During attempted removal of his right lead, the patient became somnolent with contralateral weakness and paresthesias. The procedure was aborted, and postoperative neuroimaging was immediately obtained, showing no signs of stroke or hemorrhage. The patient had almost complete control of his left arm tremor postoperatively, and his weakness soon resolved. CONCLUSION: To the best of our knowledge, this is the first reported case of cerebral injury after DBS revision and offers insights into the mechanism of high-frequency electric stimulation compared with lesions. That is, although high-frequency stimulation failed to control this patient's tremor, thalamotomy-like injury was completely effective.

scholarly journals Comparing deep brain stimulation in the ventral intermediate nucleus versus the posterior subthalamic area in essential tremor patients

2018 ◽  
Vol 9 (1) ◽  
pp. 244 ◽  
Author(s):  
PieterL Kubben ◽  
Aurélie Degeneffe ◽  
MarkL Kuijf ◽  
Linda Ackermans ◽  
Yasin Temel
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

Deep brain stimulation of the ventral intermediate nucleus in patients with essential tremor: Stimulation below intercommissural line is more efficient but equally effective as stimulation above

2011 ◽  
Vol 230 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Michael T. Barbe ◽  
Lena Liebhart ◽  
Matthias Runge ◽  
Janina Deyng ◽  
Esther Florin ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain ◽  
Stimulation Of

Benefits and risks of unilateral and bilateral ventral intermediate nucleus deep brain stimulation for axial essential tremor symptoms

2019 ◽  
Vol 60 ◽  
pp. 126-132 ◽  
Author(s):  
Kyle T. Mitchell ◽  
Paul Larson ◽  
Philip A. Starr ◽  
Michael S. Okun ◽  
Robert E. Wharen ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

scholarly journals Effects of ventral intermediate nucleus deep brain stimulation across multiple effectors in essential tremor

2020 ◽  
Vol 131 (1) ◽  
pp. 167-176 ◽  
Author(s):  
B.J. Wilkes ◽  
A. Wagle Shukla ◽  
A. Casamento-Moran ◽  
C.W. Hess ◽  
E.A. Christou ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

Comparative connectivity correlates of dystonic and essential tremor deep brain stimulation

Brain ◽  
2021 ◽  
Author(s):  
Takashi Tsuboi ◽  
Joshua K Wong ◽  
Robert S Eisinger ◽  
Lela Okromelidze ◽  
Mathew R Burns ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Structural Connectivity ◽  
Cortical Network ◽  
Dystonic Tremor ◽  
Intermediate Nucleus ◽  
Ventral Intermediate Nucleus ◽  
Deep Brain

Abstract The pathophysiology of dystonic tremor and essential tremor remains partially understood. In patients with medication-refractory dystonic tremor or essential tremor, deep brain stimulation (DBS) targeting the thalamus or posterior subthalamic area has evolved into a promising treatment option. However, the optimal DBS targets for these disorders remains unknown. This retrospective study explored the optimal targets for DBS in essential tremor and dystonic tremor using a combination of volumes of tissue activated estimation and functional and structural connectivity analyses. We included 20 patients with dystonic tremor who underwent unilateral thalamic DBS, along with a matched cohort of 20 patients with essential tremor DBS. Tremor severity was assessed preoperatively and approximately 6 months after DBS implantation using the Fahn-Tolosa-Marin Tremor Rating Scale. The tremor-suppressing effects of DBS were estimated using the percentage improvement in the unilateral tremor-rating scale score contralateral to the side of implantation. The optimal stimulation region, based on the cluster centre of gravity for peak contralateral motor score improvement, for essential tremor was located in the ventral intermediate nucleus region and for dystonic tremor in the ventralis oralis posterior nucleus region along the ventral intermediate nucleus/ventralis oralis posterior nucleus border (4 mm anterior and 3 mm superior to that for essential tremor). Both disorders showed similar functional connectivity patterns: a positive correlation between tremor improvement and involvement of the primary sensorimotor, secondary motor and associative prefrontal regions. Tremor improvement, however, was tightly correlated with the primary sensorimotor regions in essential tremor, whereas in dystonic tremor, the correlation was tighter with the premotor and prefrontal regions. The dentato-rubro-thalamic tract, comprising the decussating and non-decussating fibres, significantly correlated with tremor improvement in both dystonic and essential tremor. In contrast, the pallidothalamic tracts, which primarily project to the ventralis oralis posterior nucleus region, significantly correlated with tremor improvement only in dystonic tremor. Our findings support the hypothesis that the pathophysiology underpinning dystonic tremor involves both the cerebello-thalamo-cortical network and the basal ganglia-thalamo-cortical network. Further our data suggest that the pathophysiology of essential tremor is primarily attributable to the abnormalities within the cerebello-thalamo-cortical network. We conclude that the ventral intermediate nucleus/ventralis oralis posterior nucleus border and ventral intermediate nucleus region may be a reasonable DBS target for patients with medication-refractory dystonic tremor and essential tremor, respectively. Uncovering the pathophysiology of these disorders may in the future aid in further improving DBS outcomes.

Sign in / Sign up

Export Citation Format

Share Document