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Published on: December 13, 2017
Successful thalamic deep brain stimulation for orthostatic tremor
Jorge Guridi1, Maria C Rodriguez-Oroz, Javier Arbizu
1Department of Neurology, Neurophysiology and Neurosurgery, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain.
Summary
Deep brain stimulation (DBS) targeting the ventralis intermedius nucleus (Vim) effectively controlled severe orthostatic tremor (OT) in a patient unresponsive to medication. This Vim-DBS approach offers a promising therapeutic option for disabling OT.
Area of Science:
- Neurology
- Neurosurgery
- Movement Disorders
Background:
- Orthostatic tremor (OT) is a rare, disabling movement disorder characterized by rapid tremor during standing.
- Pharmacological treatments for OT often yield limited efficacy, necessitating alternative therapeutic strategies.
Observation:
- A patient with severe, pharmacologically refractory orthostatic tremor underwent deep brain stimulation (DBS).
- The DBS system targeted the ventralis intermedius nucleus (Vim) of the thalamus.
Findings:
- Thalamic (Vim) DBS successfully controlled the patient's severe orthostatic tremor over a 4-year period.
- Electroencephalography (EEG) back-averaging and fluoro-deoxi-glucose positron emission tomography (FDG-PET) revealed suppressed cortical activity correlating with tremor arrest.
- The Vim-DBS intervention demonstrated sustained efficacy in managing disabling OT symptoms.
Implications:
- This case highlights thalamic (Vim) DBS as a potentially effective therapeutic intervention for severe orthostatic tremor.
- Vim-DBS may offer a valuable treatment option for patients with highly disabling OT unresponsive to conventional therapies.
- Further research into Vim-DBS for OT could expand treatment paradigms for this challenging condition.
