Thalamic Deep Brain Stimulation for the Treatment of Action Myoclonus Caused by Perinatal Anoxia

Abstract

Background: Perinatal anoxia rarely causes myoclonus as the main neurologic abnormality. The exact neuronal mechanism underlying myoclonus induced by perinatal anoxia remains unknown. Some studies have indicated that the development of involuntary movements may be related to the maturation of the thalamus after birth. Objectives and Methods: Here, we describe the first case of a patient who developed action myoclonus after experiencing perinatal anoxia and was successfully treated by chronic deep brain stimulation (DBS) of the thalamus (thalamic DBS). Results andConclusion: The effectiveness of chronic thalamic DBS in this patient supports the concept of involvement of the thalamus in postperinatal anoxic myoclonus.

Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients

“…These effects were directly related to stimulation and decayed rapidly after turning off the stimulator. Tha lamic DBS has already been described for the treatment of myoclonus caused by perinatal anoxia 16 and in myoclonus dystonia syndrome. 12,17 Thalamic electrodes for the treat ment of myoclonus are usually positioned into the ventral intermediate nucleus of the thalamus, 25 which is located far from our target even when taking into account the rela tive shrinkage and distortion of the thalamus commonly seen in patients with a DOC.…”

Improvement of Post-hypoxic Myoclonus with Bilateral Pallidal Deep Brain Stimulation: A Case Report and Review of the Literature

“…Two of those cases were pallidal stimulation—one of which was unilateral to treat hemimyoclonus following a stroke,9 while the other was a bilateral implantation that effectively treated CPA-induced myoclonus in all extremities 11. Khobayashi et al10 reported a case of perinatal anoxia-induced action myoclonus successfully treated with bilateral VIM-DBS. The programming parameters for these cases all utilized a bipolar configuration to achieve therapeutic gain, whereas a monopolar and tripolar configuration in our patient, produced robust responses at amplitudes >2.5 V without any side effects.…”

Post-hypoxic Myoclonus: Current Concepts, Neurophysiology, and Treatment

“…In a case of perinatal hypoxia, the target of stimulation was the thalamus but in the other two cases the stimulation target was the globus pallidus internus. 51 , 52 , 53 Further work on deep brain stimulation surgery will hopefully confirm effectiveness and clarify the preferred site of stimulation. Intrathecal baclofen therapy has also been shown to improve myoclonus in a patient refractory to multiple medications.…”