Session Information
Date: Saturday, October 6, 2018
Session Title: Surgical Therapy: Other Movement Disorders
Session Time: 1:45pm-3:15pm
Location: Hall 3FG
Objective: The clinical course and long term outcome up to 5 years post surgery of a sample of 4 patients with medical refractory HT who underwent DBS of the thalamic ventral intermediate nucleus (VIM) are presented.
Background: Holmes Tremor (HT) is characterized by a disabling large amplitude rest, postural and kinetic tremor. The response to medical therapies is often poor and deep brain stimulation (DBS) of thalamic targets might offer a more effective tremor reduction. However, there are only limited data regarding the long term clinical outcome of patients with HT after DBS.
Methods: Tremor severity was quantified by two blinded raters using the Fahn-Tolosa-Marin (FTM) tremor rating scale on video examinations from baseline visit, 4-6 months (stimulation ON/OFF) and 3-5 years (stim ON) post surgery. Life quality was measured by using the the Bain and Findley tremor activities of daily living (ADL) self-assessment. Electrode positions were located in preoperative MRI scans after fusioning with postoperative cranial computertomographic scans.
Results: Between 2002 and 2008 four patients (two with ischemic lesions of the posterior thalamus, one with hypertensive intracerebral bleeding of the ventroposterior thalamus and one with a posttraumatic lesion of the dorso-lateral thalamus) underwent implantation of DBS electrodes into the VIM. One patient did not show any clinical response to stimulation and postoperative MRI revealed a mislocalization of the electrode. After two years revision surgery was performed and in the course of this the electrode was finally explanted. In the other 3 patients baseline mean FTM score was 38 (minimum-maximum: 21-55) and ADL score was 41 (40-42). After 4 to 6 months post surgery the mean FTM score in stimulation ON was 23 (18-27; mean improvement 39%) and ADL score was 37 (31-43; 11% improvement). After 3 to 5 years the mean FTM score was 28 (20-45; 26% improvement compared to baseline) and ADL score was 45 (40-52; 11% worsening compared to baseline).
Conclusions: Out of 4 patients only 2 had a clear tremor reduction (>30%) in the FTM scale within six months post surgery. In the long term over 5 years in these 2 patients a clear tremor reduction compared to baseline was maintained. The clinical outcome after VIM DBS in HT seems very variable and the electrode localization may play an important role.
To cite this abstract in AMA style:
J. Becktepe, S. Paschen, F. Goevert, A. Helmers, G. Deuschl. Long term clinical outcome after deep brain stimulation of the thalamic VIM in Holmes Tremor: A case series [abstract]. Mov Disord. 2018; 33 (suppl 2). https://www.mdsabstracts.org/abstract/long-term-clinical-outcome-after-deep-brain-stimulation-of-the-thalamic-vim-in-holmes-tremor-a-case-series/. Accessed October 7, 2024.« Back to 2018 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-clinical-outcome-after-deep-brain-stimulation-of-the-thalamic-vim-in-holmes-tremor-a-case-series/