Objective: We aimed to evaluate the clinical benefit of Vim DBS in patients with dystonic head tremor.

Background: Deep brain stimulation (DBS) of the internal globus pallidus (GPi) has become an accepted treatment for segmental and generalized dystonia. In severe tremor syndromes the thalamic ventral intermedius nucleus (Vim) is usually the DBS target of choice. Few case reports on thalamic DBS in dystonia have been reported. Patient with dystonic tremor might as well benefit from thalamic DBS.

Methods: Patients with dystonic head tremor were scheduled for Vim DBS. All patients were clinically characterized according to the Burke-Fahn-Marsden (BFM) motor and disability rating scale (BFM-M/BFM-D) and the modified Fahn-Tolosa-Marin Tremor Rating Scale (mFTMTRS) (0-12 point scale for head tremor) pre- and postoperatively. Statistical analysis for significant pre- and postoperative changes in BFM-M/BFM-D and mFTMTRS was performed using the Wilcoxon Rank test for paired variables.

Results: 15 consecutive patients with dystonic head tremor underwent Vim DBS (6 male, mean age at DBS 49.7 +/- 11.8 years). Mean follow-up (FU) duration was 41 months (median 17 months). The mean preoperative BFM-M was 21.8 +/- 11.5, which improved to 12.2 +/- 10.5 at last FU (-44.5%, p<0.05), and the mean preoperative BFM-D was 5.1 +/- 2.9, which improved to 3.4 +/- 4.1 at last FU (-33.3%, p<0.05), while the mean preoperative mFTMTRS was 8.7 +/- 2.5, which improved to 3.5 +/- 2.7 at last FU (-59.8%, p<0.005).

Conclusions: Thalamic DBS should be considered as a primary therapeutic option in patients with segmental dystonia with prominent tremor. Indeed, patients experienced a significant relief of their tremor but also other dystonic symptoms improved significantly as reflected by the BFM.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/thalamic-deep-brain-stimulation-of-the-ventral-intermediate-nucleus-in-patients-with-dystonic-head-tremor/