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Long-Term Outcome and Neuroimaging of Deep Brain Stimulation in Holmes Tremor: A Case Series
Panagiotis Bargiotas1,2, T A Khoa Nguyen3,4, Tobias Bracht5
1Department of Neurology, University Hospital Bern (Inselspital) and University of Bern, Bern, Switzerland.
Insights
Deep brain stimulation (DBS) for Holmes tremor (HT) offers initial symptom relief, but benefits may not be long-lasting. Electrode targeting and VTA proximity are crucial for optimizing DBS treatment outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Biomedical Engineering
Background:
- Pharmacologically refractory Holmes tremor (HT) presents a treatment challenge.
- Deep brain stimulation (DBS) is explored as a therapeutic option for HT.
- This study investigates long-term outcomes of DBS in four HT patients.
Observation:
- Patients received DBS targeting either the VIM or DRTT.
- Clinical evaluations included tremor severity (FTMTRS) and activities of daily living (ADL) assessments.
- Quality of life (QoL) was measured using the RAND SF-36, and VTA was computed using LEAD-DBS.
Findings:
- Significant short-term improvement in tremor and ADL was observed post-DBS.
- Sustained tremor improvement was seen in only one of four patients up to nine years.
- ADL scores deteriorated over time in most patients, and QoL changes were independent of motor outcomes.
Implications:
- Long-term efficacy of DBS for HT can be variable.
- Accurate targeting and VTA analysis are vital for optimizing DBS programming.
- Further research is needed to improve sustained therapeutic benefits of DBS in HT.
Background:
Different deep brain stimulation (DBS) targets have been suggested as treatment for patients with pharmacologically refractory Holmes tremor (HT). We report the clinical and quality of life (QoL) long-term (up to nine years) outcome in four patients with HT treated with DBS (in thalamic ventral intermediate nucleus-VIM or in dentato-rubro-thalamic tract-DRTT).
Materials And Methods:
The patients underwent routine clinical evaluations before and after DBS (typically annually). Tremor severity and activities of daily living (ADL) were quantified by the Fahn-Tolosa-Marin Tremor-Rating-Scale (FTMTRS). QoL was assessed using the RAND SF-36-item Health Survey (RAND SF-36). In addition, we computed, in all four patients, the VTA based on the best stimulation settings using heuristic approaches included in the open source toolbox LEAD-DBS.
Results:
In all patients, tremor and ADL improved significantly at one-year post-DBS follow-up (34-61% improvement in FTMTRS total score compared to baseline). In three out of four patients, the improvement of tremor was sustained no longer than two to three years and only in one patient was sustained up to nine years. In this patient, the largest intersection between VTA and DBS target has been observed. Scores for ADL deteriorated over the course of time, reaching worse levels compared to baseline already during the three-year post-DBS follow-up, in three out of four patients. Physical and mental health component scores of RAND SF-36 had very different outcome between patients and follow-ups and were not associated with tremor-related outcomes.
Conclusions:
The benefits of DBS in HT might not be always long lasting. Although QoL slightly improved, this change seemed to be independent of the motor outcome following DBS. The estimation of DBS target and VTA proximity could be a useful tool for DBS clinicians in order to facilitate the DBS programming process and optimize DBS treatment.
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