What Should be the Anatomical Target in Deep Brain Stimulatıon in an Essential Tremor Plus Rest Tremor Case? Technical Case Report of Deep Brain Stimulation

Year 2024, Volume: 2 Issue: 3, 99 - 102, 25.09.2024

Nilüfer Büyükkoyuncu Pekel , Demet Yıldız

https://doi.org/10.61678/bursamed.1515924

Abstract

While Deep Brain Stimulation (DBS) of Subthalamic Nucleus (STN) is effective on resting tremors, but its effectiveness on postural and kinetic tremors is limited. DBS of the Ventral Intermediate Nucleus (VIM) is effective on many types of tremors, especially postural and kinetic tremors, but its effect is weak on motor symptoms in Parkinson’s disease (PD). Although there is a consensus in the literature about where the anatomical target should be in essential tremor (ET) and PD, there are only case reports about where the anatomical target should be in Essential Tremor Plus Rest Tremor (ET+RT) cases.In this article, we aimed to reveal the effectiveness of STN DBS in a case-diagnosed with ET+RT. The patient had action tremors in both upper extremities for 21 years and developed rest tremors in both upper and lower extremities for the last six years. Rest tremor was effectively controlled with bilateral STN DBS. Postural tremor in the right upper extremity was continued, although it decreased.STN may be an appropriate choice when choosing an anatomical target in DBS in cases of resting, postural, and kinetic tremor.

Keywords

Essential tremor plus rest tremor, deep brain stimulation, subtalamic nucleus

References

• Deuschl G, Bain P, Brin M. Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee. Mov Disord. 1998;13 Suppl 3:2-23. doi: 10.1002/mds.870131303.
• Louis ED, Ferreira JJ. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord. 2010 Apr 15;25(5):534-41. doi: 10.1002/mds.22838.
• İlhan Alp, S. (2020). İSTANBUL- MALTEPE İLÇESİNDE 18-60 YAŞ ARASI BİREYLERDE ESANSİYEL TREMOR PREVALANSI ve TÜRKİYE ESANSİYEL TREMOR PREVELANS ÇALIŞMALARININ ANALİZİ*. International Anatolia Academic Online Journal Health Sciences, 6(2), 222-239.
• Pandey S. Is essential tremor a family of diseases or a syndrome? A syndrome. Int Rev Neurobiol. 2022;163:31-59. doi: 10.1016/bs.irn.2022.02.002.
• Rajalingam R, Breen DP, Chen R, Fox S, Kalia LV, Munhoz RP, Slow E, Strafella AP, Lang AE, Fasano A. The clinical significance of lower limb tremors. Parkinsonism Relat Disord. 2019 Aug;65:165-171. doi: 10.1016/j.parkreldis.2019.06.007.
• Chandra V, Hilliard JD, Foote KD. Deep brain stimulation for the treatment of tremor. J Neurol Sci. 2022 Apr 15;435:120190. doi: 10.1016/j.jns.2022.120190.
• Steffen JK, Jergas H, Petry-Schmelzer JN, Dembek TA, Thies T, Jost ST, Dafsari HS, Kessler J, Wirths J, Fink GR, Visser-Vandewalle V, Barbe MT. Thalamic Deep Brain Stimulation in Essential Tremor Plus Is as Effective as in Essential Tremor. Brain Sci. 2020 Dec 11;10(12):970. doi: 10.3390/brainsci10120970.
• Stover NP, Okun MS, Evatt ML, Raju DV, Bakay RA, Vitek JL. Stimulation of the subthalamic nucleus in a patient with Parkinson disease and essential tremor. Arch Neurol. 2005 Jan;62(1):141-3. doi: 10.1001/archneur.62.1.141.
• Oertel MF, Schüpbach WM, Ghika JA, Stieglitz LH, Fiechter M, Kaelin-Lang A, Raabe A, Pollo C. Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson's disease. Acta Neurochir (Wien). 2017 Feb;159(2):265-269. doi: 10.1007/s00701-016-3044-5.
• Liu B, Xu J, Feng Z, Hui R, Zhang Y, Liu D, Chang Q, Yu X, Mao Z. One-pass deep brain stimulation of subthalamic nucleus and ventral intermediate nucleus for levodopa-resistant tremor-dominant Parkinson's disease. Front Aging Neurosci. 2023 Dec 21;15:1289183. doi: 10.3389/fnagi.2023.1289183.
• Kaptan H, Çakmur R. Technical Case Report of Deep Brain Stimulation: Is it Possible Single Electrode Reach to Both of Subthalamic Nucleus and Ventral Intermediate Nucleus in One Stage? Open Access Maced J Med Sci. 2018 Apr 2;6(4):659-662. doi: 10.3889/oamjms.2018.137.
• Falconer RA, Rogers SL, Shenai M. Using Directional Deep Brain Stimulation to Co-activate the Subthalamic Nucleus and Zona Incerta for Overlapping Essential Tremor/Parkinson's Disease Symptoms. Front Neurol. 2018 Jul 5;9:544. doi: 10.3389/fneur.2018.00544.
• Prasad S, Pal PK. Reclassifying essential tremor: Implications for the future of past research. Mov Disord. 2019 Mar;34(3):437. doi: 10.1002/mds.27615.
• Rajalingam R, Breen DP, Lang AE, Fasano A. Essential tremor plus is more common than essential tremor: Insights from the reclassification of a cohort of patients with lower limb tremor. Parkinsonism Relat Disord. 2018 Nov;56:109-110. doi: 10.1016/j.parkreldis.2018.06.029.
• Erro R, Sorrentino C, Russo M, Barone P. Essential tremor plus rest tremor: current concepts and controversies. J Neural Transm (Vienna). 2022 Jul;129(7):835-846. doi: 10.1007/s00702-022-02516-2.