Deep Brain Stimulation Management of Essential Tremor with Dystonic Features

Tremor and Other Hyperkinetic Movements

article

Amar Patel¹  Wissam Deeb²  Michael S. Okun² 

[1] Department of Neurology, Yale School of Medicine, Yale University;Fixel Center for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida

关键词: Essential tremor;    dystonia;    dystonic tremor;    deep brain stimulation;   

DOI  :  10.5334/tohm.426

学科分类：社会科学、人文和艺术（综合）

来源: Ubiquity Press

【 摘 要 】

Clinical Vignette: A 64-year-old female with essential tremor (ET) presents for evaluation of deep brain stimulation (DBS) candidacy. Examination revealed subtle dystonic features as well as a disabling postural-action tremor. Clinical Dilemma: Can dystonia occur in the setting of the diagnosis of ET and can its presence alter DBS target selection? Clinical Solution: Unilateral DBS implantation of the ventralis intermedius (Vim) led to improvement in both tremor and dystonic posturing. Gap in Knowledge: Case reports of DBS in dystonic tremor suggest Vim, globus pallidus internus (GPi), and subthalamic targets may all be effective, to varying degrees, in improving both tremor and dystonia. More rigorous studies are needed to identify the optimal target(s). Expert Commentary: This case underscores the limited evidence available to guide a clinician’s choice of DBS targets in patients with ET and dystonia. The severity of the dystonia and the presence of more generalized dystonia may alter the thinking about optimal targeting. Vim, GPi, and subthalamic targets appear potentially acceptable options, though Vim is usually the first target attempted when postural-action tremor is the chief complaint. Occasionally, a second rescue DBS lead may be necessary.

【 授权许可】

CC BY