Vim thalamotomy in a patient with Holmes’ tremor and palatal tremor - Pathophysiological considerations

Maki, Futaba; Sato, Sumito; Watanabe, Katsushige; Yanagisawa, Toshiyuki; Hagiwara, Yuta; Shimizu, Takahiro; Hasegawa, Yasuhiro

doi:10.1186/s12883-015-0277-5

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…We found that surgical lesions or DBS sites that improve Holmes tremor are part of the same connected brain circuit as the lesion that caused the tremor in the first place. Although potentially counterintuitive, this finding may align with pathological oscillations recorded in Holmes tremor patients . The first lesion could unbalance the circuit, setting up a pathological oscillation, and a second hit to this same circuit could break this oscillation, providing therapeutic benefit.…”

Section: Discussionsupporting

confidence: 84%

“…Although potentially counterintuitive, this finding may align with pathological oscillations recorded in Holmes tremor patients. 35 The first lesion could unbalance the circuit, setting up a pathological oscillation, and a second hit to this same circuit could break this oscillation, providing therapeutic benefit. If the therapeutic lesion must be part of the same circuit as the causative lesion, none of our current DBS targets would be expected to improve Holmes tremor in all cases.…”

mentioning

confidence: 99%

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Mapping holmes tremor circuit using the human brain connectome

Joutsa

Shih

Fox

2019

Annals of Neurology

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Objective Holmes tremor is a debilitating movement disorder with limited treatment options. Lesions causing Holmes tremor can occur in multiple different brain locations, leaving the neuroanatomical substrate unclear. Here, we test whether lesion locations that cause Holmes tremor map to a connected brain circuit and whether this circuit might serve as a useful therapeutic target. Methods Case reports of Holmes tremor caused by focal brain lesions were identified through a systematic literature search. Connectivity between each lesion location and the rest of the brain was computed using resting state functional connectivity magnetic resonance imaging data from 1,000 healthy volunteers. Commonalities across lesion locations were identified. This Holmes tremor circuit was then compared to neurosurgical treatment targets and clinical efficacy. Results We identified 36 lesions causing Holmes tremor, which were scattered across multiple different brain regions. However, all lesion locations were connected to a common brain circuit with nodes in the red nucleus, thalamus, globus pallidus, and cerebellum. In cases with effective neurosurgical treatment, the treatment target was connected with the lesion location, indicating that a second hit to the same circuit might be beneficial. Commonly used deep brain stimulation targets such as the ventral intermediate nucleus and subthalamic nucleus fell outside our Holmes tremor circuit, whereas the globus pallidus target was close, consistent with published clinical response rates for these targets. Interpretation Lesions causing Holmes tremor are part of a single connected brain circuit that may serve as an improved therapeutic target. ANN NEUROL 2019;86:812–820

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

Mapping holmes tremor circuit using the human brain connectome

Joutsa

Shih

Fox

2019

Annals of Neurology

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“…Rare tremor syndromes, such as DBS-resistant ET or poststroke tremor, may respond favorably to thalamotomy. 15,16 In our series, neuropathic and cerebellar tremor, respectively, were treated successfully, although the latter patient had continued hand dysfunction as a result of comorbid dysmetria, which is common in cerebellar tremor. 2 Thus clear expectations should be set that comorbid preoperative cerebellar signs will not necessarily improve along with tremor, which may temper enthusiasm depending on the source of disability.…”

Section: Discussionmentioning

confidence: 67%

“…Rare tremor syndromes, such as DBS‐resistant ET or poststroke tremor, may respond favorably to thalamotomy . In our series, neuropathic and cerebellar tremor, respectively, were treated successfully, although the latter patient had continued hand dysfunction as a result of comorbid dysmetria, which is common in cerebellar tremor .…”

Section: Discussionmentioning

confidence: 72%

MRI‐guided laser interstitial thermal thalamotomy for medically intractable tremor disorders

et al. 2018

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Introduction Medically intractable tremors are a common, difficult clinical situation. Deep brain stimulation decreases Parkinson's disease resting tremor and essential tremor, but not all patients are candidates from a diagnostic, medical, or social standpoint, prompting the need for alternative surgical strategies. Methods We describe 13 patients with medically intractable tremor treated with laser interstitial thermal thalamotomy performed under general anesthesia using live MRI‐guidance and the Clearpoint stereotactic system. Results All patients had a dramatic decrease in tremor immediately postoperatively, which has been sustained through follow‐up (3‐17 months) in all but 1 patient (mean tremor score reduction of 62%; 10.33 ± 2.69 to 3.89 ± 3.1). Objective side effects were transient and included imbalance and paresthesia. Conclusion Medically intractable tremor treated with laser interstitial thermal thalamotomy may be a useful addition to the treatment armamentarium for medically intractable tremor disorders. © 2018 International Parkinson and Movement Disorder Society

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“…The surgical perforation of the tympanic membrane and the excision of the LVP, TVP and tensor tympani muscle did not provide any obvious benefit [ 82 ]. A thalamotomy also did not provide benefit in a patient with both PT and Holmes’ tremor [ 87 ]. The bilateral deep brain stimulation of the red nucleus did not reduce OPT in one patient [ 28 ].…”

Section: Treatmentmentioning

confidence: 99%

Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

Bhattacharjee

2020

Tremor and Other Hyperkinetic Movements

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Background: Palatal tremor is involuntary, rhythmic and oscillatory movement of the soft palate. Palatal tremor can be classified into three subtypes; essential, symptomatic and palatal tremor associated with progressive ataxia. Methods: A thorough Pubmed search was conducted to look for the original articles, reviews, letters to editor, case reports, and teaching neuroimages, with the keywords "essential", "symptomatic palatal tremor", "myoclonus", "ataxia", "hypertrophic", "olivary" and "degeneration". Results: Essential palatal tremor is due to contraction of the tensor veli palatini muscle, supplied by the 5 th cranial nerve. Symptomatic palatal tremor occurs due to the contraction of the levator veli palatini muscle, supplied by the 9 th and 10 th cranial nerves. Essential palatal tremor is idiopathic, while symptomatic palatal tremor occurs due to infarction, bleed or tumor within the Guillain-Mollaret triangle. Progressive ataxia and palatal tremor can be familial or idiopathic. Symptomatic palatal tremor and sporadic progressive ataxia with palatal tremor show signal changes in inferior olive of medulla in magnetic resonance imaging. The treatment options available for essential palatal tremor are clonazepam, lamotrigine, sodium valproate, flunarizine and botulinum toxin. The treatment of symptomatic palatal tremor involves the treatment of the underlying cause. Discussion: Further studies are required to understand the cause and pathophysiology of Essential palatal tremor and progressive ataxia and palatal tremor. Similarly, the link between tauopathy and palatal tremor associated progressive ataxia needs to be explored further. Oscillopsia and progressive ataxia are more debilitating than palatal tremor and needs new treatment approaches.

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Vim thalamotomy in a patient with Holmes’ tremor and palatal tremor - Pathophysiological considerations

Cited by 17 publications

References 20 publications

Mapping holmes tremor circuit using the human brain connectome

Mapping holmes tremor circuit using the human brain connectome

MRI‐guided laser interstitial thermal thalamotomy for medically intractable tremor disorders

Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

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