Category: Tremor
Objective: We present a case series of patients with refractory complex tremor treated with dual targeting DBS of ViM and pSTN/cZI.
Background: The ventral intermediate (ViM) nucleus of the thalamus is the traditional Deep Brain Stimulation’s (DBS) target for tremor. The posterior subthalamic nucleus (pSTN) including the caudal Zona Incerta (cZI) has also been demonstrated to be an effective target.
Method: Eight contacts VerciseTM Boston scientific DBS lead was utilised in all cases; pulse generator was either Vercise IPG or Gevia IPG Boston Scientific. 55 patients with complex tremor were consecutively recruited from the DBS clinics at the Walton Centre NHS Foundation Trust. 50 patients had bilateral VIM and pSTN/cZI DBS and five unilateral DBS of the same targets.
Results: The EuroQol-5D (EQ-5D) average score improved from 0.585 (SD+/-0.220) to 0.661 (SD+/- 0.187) (13%) at the six-month follow up post-DBS . This improvement was sustained at five years follow up.
The Fahn-Tolosa tremor rating scale scores showed an average improvement from 53.44 (SD +/- 12.73) to 33.27 (SD+/- 17.87) six months post-implantation (37.74%). Sustained improvement was demonstrated at five year follow up.
Conclusion: Overall, this study indicated that that dual target stimulation of VIM and pSTN/cZI is an effective target for complex refractory tremor.
References: 1. Degeneffe A, Kuijf ML, Ackermans L, Temel Y, Kubben PL. Comparing deep brain stimulation in the ventral intermediate nucleus versus the posterior subthalamic area in essential tremor patients. Surg Neurol Int. 2018 Dec 4;9:244. doi: 10.4103/sni.sni_234_18. PMID: 30603229; PMCID: PMC6293600.
2. De Marco R, Bhargava D, Macerollo A, Osman-Farah J. Could ZI have a role in DBS for Parkinson’s Disease? An observational study to optimize DBS target localization. J Clin Neurosci. 2020 Jul;77:89-93. doi: 10.1016/j.jocn.2020.05.029. Epub 2020 May 10. PMID: 32402608.
To cite this abstract in AMA style:
R. Heartshorne, J. Osman-Farah, A. Macerollo. Dual target deep brain stimulation for clinically complex tremor disorders: a single centre prospective study [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/dual-target-deep-brain-stimulation-for-clinically-complex-tremor-disorders-a-single-centre-prospective-study/. Accessed May 13, 2025.« Back to 2022 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/dual-target-deep-brain-stimulation-for-clinically-complex-tremor-disorders-a-single-centre-prospective-study/