Objective: We aim to investigate whether the body region affected by dystonic tremor and dystonia is important for target selection.
Background: For the treatment of combined tremor and dystonia syndromes, either thalamic or pallidal deep brain stimulation (DBS) may be considered in dependency of the predominant symptom. In some patients no sufficient tremor suppression is achieved by the first target and additional rescue lead implantation is required.
Method: Four cases with severe action tremors of different body distribution combined with cervical dystonia who did not respond to the primary stimulation target but to additional rescue lead implantation are presented. Outcome parameters were assessed in observer blinded video ratings and included the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS) and the Unified Dystonia Rating Scale (UDRS).
Results: Two patients with predominant lateralized action tremor of the hands and mild cervical dystonia showed no relevant tremor improvement after GPi stimulation but the UDRS improved by an average of 45 %. Rescue Vim-DBS electrodes were implanted and both patients benefited considerably with a mean tremor reduction of 51% (FTM-TRS). Two other patients with a rapid progressive axial-predominant action tremor of the trunk and head combined with cervical dystonia underwent bilateral Vim-DBS implantation with little effect on tremor (24% reduction of the mean FTM-TRS total score) and no effect on dystonic symptoms. Rescue GPi-DBS was implanted and combined Vim/GPi long-term stimulation showed an additive effect on tremor (75% mean FTM-TRS reduction) and dystonia (49% reduction in UDRS).
Conclusion: The anatomical tremor distribution (axial versus distal extremities) in patients with cervical dystonia may play a role for the stimulation response to thalamic and pallidal targets.
To cite this abstract in AMA style:
S. Paschen, J. Becktepe, M. Hobert, K. Zeuner, A. Helmers, D. Berg, G. Deuschl. The efficacy of thalamic and pallidal deep brain stimulation rescue leads in dystonic tremor depends on the affected body region – a case series [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/the-efficacy-of-thalamic-and-pallidal-deep-brain-stimulation-rescue-leads-in-dystonic-tremor-depends-on-the-affected-body-region-a-case-series/. Accessed September 28, 2023.« Back to 2023 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/the-efficacy-of-thalamic-and-pallidal-deep-brain-stimulation-rescue-leads-in-dystonic-tremor-depends-on-the-affected-body-region-a-case-series/