Holmes Tremor in CADASIL Responsive to Multi-Targeting Deep Brain Stimulation (DBS): An Educational Case with Video and Electrophysiology

Fahimeh H. Akhoundi; Katherine Longardner; Dietrich Haubenberger; Robert Hess; Brenton A. Wright; Sharona Ben-Haim

doi:10.5334/tohm.1128

Holmes Tremor in CADASIL Responsive to Multi-Targeting Deep Brain Stimulation (DBS): An Educational Case with Video and Electrophysiology

Volume 16 (2026): Issue 1

By: Fahimeh H. Akhoundi , Katherine Longardner , Dietrich Haubenberger , Robert Hess, Brenton A. Wright and Sharona Ben-Haim

Open Access

|May 2026

Abstract

Background: Holmes tremor (HT) is a disabling condition, often resistant to medical therapy.

Case report: A 51-year-old woman with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) presented with severe right upper limb HT unresponsive to multiple medications. She underwent deep brain stimulation (DBS) with dual-lead, triple-targeting of the left ventral intermediate nucleus (VIM), posterior subthalamic area (PSA), and globus pallidus interna (GPi) with improvement in tremor.

Discussion: To our knowledge, this case represents the first reported instance of HT in CADASIL and highlights the potential of multi-target DBS for complex, treatment-refractory hyperkinetic movement disorders.

Highlights

We describe the first reported instance of Holmes tremor occurring as a manifestation of CADASIL, successfully treated with triple-target deep brain stimulation of the VIM, PSA, and GPi. This case demonstrates the potential of multi-target DBS to modulate complex motor networks in treatment-resistant tremor and enhance functional outcomes.

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Articles in this issue

DOI: https://doi.org/10.5334/tohm.1128 | Journal eISSN: 2160-8288

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Language: English

Page range: 30 - 30

Submitted on: Nov 6, 2025

Accepted on: Apr 2, 2026

Published on: May 8, 2026

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Holmes tremor,

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL),

NOTCH3,

Deep Brain Stimulation (DBS),

Electrophysiology,

Tremor

© 2026 Fahimeh H. Akhoundi, Katherine Longardner, Dietrich Haubenberger, Robert Hess, Brenton A. Wright, Sharona Ben-Haim, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 16 (2026): Issue 1