Objective: This clinical study highlights 10 cases treated at the Walton Centre NHS Foundation Trust (Liverpool, UK) wherein DBS has been implemented beyond unilateral and singular target procedures. It describes the immediate and long-term response and effects of multiple-target DBS in patients with dystonia and complex tremor syndromes (including Holmes tremor).
Background: Deep Brain Stimulation (DBS) is an established neurosurgical procedure for pharmacologically refractory dystonia and complex tremor syndromes. Multiple target stimulation, such as internal globus pallidus (GPi) and ventral intermediate nucleus (VIM) stimulation, can be used to achieve the control of dystonic features as well as the severe tremor at the same time.
Method: Case notes were reviewed retrospectively for the included patients. Data were collected from baseline and subsequent appointments, including treatment details, quantitative and qualitative findings, and side effects. Metrics included the cervical dystonia scale TWSTRS, Fahn-Marsden dystonia scale, FTM scale for tremor, EQ-5D for quality of life, and HADS Anxiety and HADS Depression scores.
Results: Our cohort experienced symptom relief following multi-target DBS, with varying levels of symptom suppression and stimulation-related side effects (i.e. slurred speech, gait disturbance); stimulation adjustments were made accordingly. Importantly, there were discrepancies in objective clinical improvement and perceived symptom relief by the patients.
Conclusion: Multi-target DBS can be useful in managing dystonia and complex tremor cases; it requires balancing symptoms improvement with side effects through continued follow-up and setting adjustments. Tremor suppression and side effect profiles are patient dependent, with varying levels of success demonstrated in our case series.
To cite this abstract in AMA style:
A. Shiramba, J. Panicker, D. Bhargava, J. Osman Farah, A. Macerollo. Multi-target Deep Brain Stimulation for Dystonia and Complex tremor syndromes: A Single-Centre Case Series and Literature Review [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/multi-target-deep-brain-stimulation-for-dystonia-and-complex-tremor-syndromes-a-single-centre-case-series-and-literature-review/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/multi-target-deep-brain-stimulation-for-dystonia-and-complex-tremor-syndromes-a-single-centre-case-series-and-literature-review/