A 67-year-old, right-handed man had a 7-year history of right-dominant, severe medication-refractory resting and action-postural tremor, rigidity, bradykinesia, and impairment of postural reflexes, with his symptoms poorly responsive to oral antiparkinsonian medication. His parkinsonian symptoms with the exception of tremor responded to levodopa infusion. His most bothersome symptom was tremor, and implantation of a left subthalamic nucleus (STN) deep brain stimulation (DBS) lead was pursued with possible posterior subthalamic area (PSA) DBS if the tremor suppression by STN was not intraoperatively sufficient. Ultimately, the STN DBS lead provided reasonable tremor suppression during the operation, and there was no need for PSA DBS. After the surgery, his tremor and other parkinsonian symptoms were well-controlled. This case highlights that unilateral STN DBS is a reasonable indication for medication-refractory parkinsonian tremor with significant laterality of bothersome symptoms, although other options may also be considered.
An integrated wearable robot for tremor suppression with context aware sensing
