Deep Brain Stimulation in Posttraumatic Tremor: A Series of Cases and Literature Review

Abstract

Background: Posttraumatic tremor (PTT) is the most frequent movement disorder secondary to cranioencephalic trauma and can be persistent and disabling. Objectives: We review and assess the efficacy of deep brain stimulation (DBS) at the VIM/VOP/ZI (ventralis intermedius/ventrooralis posterior/zona incerta) complex level for the treatment of PTT. Methods: During the period from 1999 to 2014, 5 patients diagnosed with PTT were selected who had experienced a major deterioration in their quality of life without improvement during medical treatment for more than 1 year. They underwent surgery for DBS at the VIM/VOP/ZI complex level, and the modified tremor scale before and after surgery was used for their follow-up. Results: Each patient showed improvements in their symptoms after DBS compared with baseline, which was moderate (II) in 2 cases and marked (III) in the other cases. All of the improvements were maintained with chronic DBS, without tremor rebound. Conclusions: Stimulation of the contralateral VIM/VOP/ZI complex resulted in a noticeable improvement in tremor and recovery of independence in basic daily activities in patients with PTT.

Deep brain stimulation in post‐traumatic dystonia: A case series study

“…VIM was selected as the target for the disabling tremor, but surprisingly we found that stimulation of VIM also attenuated the focal hand dystonia. Besides, some case reports also indicated that VIM DBS resulted in improved dystonia as well as tremor reduction.…”

Successful treatment of focal hand dystonia after cervical whiplash injury by thalamotomy

“…[ 8 ] The effectiveness of Vim thalamotomy has also been previously reported. [ 11 , 12 ] Moreover, recurrence after Vo thalamotomy has been reported to occur due to insufficient or incorrect coagulation over the entire Vo nucleus of the thalamus. [ 7 ] In our case, the thalamotomy lesion after the first operation did not cover a part of the Vo nucleus [ Figure 2 ].…”

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

“…Proper management of post-traumatic tremor is limited by the lack of effectiveness of pharmacological approaches, leading to a growing interest in surgical techniques ( Mendonça et al, 2018 ; Wang et al, 2020 ). Several systematic reviews have been published on a small pool of patients in the literature – fewer than 100 to date – and have found that deep brain stimulation can be an effective therapeutic modality and can provide greater postural tremor suppression compared with medical management ( Rojas-Medina et al, 2016 ; Artusi et al, 2018 ; Wang et al, 2020 ).…”

“…Following severe TBI, 13–66% of patients have persistent and disabling movement disorders including various combinations of tremors and dystonia ( Krauss and Jankovic, 2002 ). Stereotactic surgery is an effective form of therapy for these difficult to treat disorders with thalamotomy and deep brain stimulation (DBS) demonstrating variable but often long-term functional benefits ( Krauss and Jankovic, 2002 ; Rojas-Medina et al, 2016 ; Artusi et al, 2018 ; Mendonça et al, 2018 ). Given the variable movement disorder phenomenology in TBI, it is likely that the underlying pathophysiology involves multiple motor circuits.…”

“…Thus, in addition to the distorted anatomy in these patients, it is often unclear which stimulation targets are ideal. The ventral intermediate nucleus of thalamus (Vim), globus pallidus internus (GPi), and ventral oralis posterior/anterior of thalamus (VOP/VOA) are some of the more widely used targets ( Espinoza Martinez et al, 2015 ; Rojas-Medina et al, 2016 ; Artusi et al, 2018 ; Mendonça et al, 2018 ). Distortion of standard anatomy portends a complexity which necessitates patient-specific lead targeting and implantation protocols that maximize symptom improvement while minimizing adverse outcomes.…”