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Case Report: Dual Target Deep Brain Stimulation With Externalized Programming for Post-traumatic Complex Movement

Ron Gadot1, Ben Shofty1, Ricardo A Najera1

  • 1Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States.

Frontiers in Neuroscience
|November 25, 2021
PubMed
Summary
This summary is machine-generated.

Deep brain stimulation (DBS) effectively treated severe post-traumatic tremor by using advanced imaging and lead testing. This personalized approach improved patient outcomes for movement disorders after brain injury.

Keywords:
DRTT = dentato-rubro-thalamic tractdeep brain stimulationmovement disordertraumatremor

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Area of Science:

  • Neurosurgery
  • Neurology
  • Neuroscience

Background:

  • Movement disorders are common, debilitating consequences of severe traumatic brain injury (TBI).
  • Conventional medical management often proves insufficient for complex post-traumatic movement disorders.
  • Deep brain stimulation (DBS) offers a therapeutic option, but anatomical distortions from TBI complicate surgical targeting.

Observation:

  • A 42-year-old male patient presented with severe, disabling post-traumatic tremor.
  • The patient underwent bilateral, dual-target DBS to the globus pallidus internus (GPi) and a combined ventral intermediate nucleus of the thalamus (Vim)/dentato-rubro-thalamic tracts (DRTT) target.
  • Diffusion tractography was used preoperatively to guide targeting due to distorted anatomy.

Findings:

  • Externalized DBS leads allowed for extra-operative testing and optimization before permanent implantation.
  • Six months post-surgery, the patient experienced a 67% reduction in tremor and dystonia burden.
  • The Essential Tremor Rating Scale (TETRAS) performance sub-score significantly improved.

Implications:

  • A tailored surgical strategy incorporating patient-specific anatomy and tractography is crucial for optimizing DBS outcomes in post-TBI movement disorders.
  • Extra-operative lead testing with externalized leads can enhance surgical precision and efficacy.
  • This approach demonstrates a promising method for managing refractory post-traumatic tremor.