Table 1
Case Reports and Series of Thalamic and Subthlamic Deep Brain Stimulation in Patients with Holmes Tremor
| Study | Number of Patients and Etiology | Target | Outcome | Follow-up |
|---|---|---|---|---|
| Studies reporting VIM DBS for HT | ||||
| Pahwa et al.7 | Midbrain cavernous hemangioma (symptoms for 3 years) | Right VIM | Significant improvement in postural and resting tremor; kinetic component persisted | 10 months |
| Samadani et al. 200312 | Left midbrain cavernous malformation (symptoms for 4 years) | Right VIM | 57% increase in dexterity and four-point decrease in functional disability in TRS | N/A |
| Nikkhah et al. 200413 | 1. Right infarct midbrain (tremor symptoms 6 months); 2. Left thalamic AVM | 2 patients with Contralateral VIM | Almost complete tremor resolution (80% improvement). Dystonia and rigidity benefit reported | 7 months and 6 months respectively |
| Piette et al. 200414 | Pontine tegmental hemorrhage | Right VIM | Major functional improvement | 16 months |
| Diederich et al.33 | 1. Left venous pontine angioma (symptoms for 7 years) 2. Right midbrain hemiatrophy (symptoms for 32 years) | 2 patients with contralateral VIM | Substantially ameliorated postural>rest>intention component | 7 years and 5 years respectively |
| Peker et al. 200815 | Left thalamic abscess (symptoms 18 months) | Right VIM | 90% overall improvement | 2.5 years |
| Acar et al. 201016 | Subarachnoid hemorrhage (symptoms less than 1 month) | Bilateral VIM | No tremor and reduction in disability due to tremor. | 3 months |
| Castrop et al. 201317 | 1. Hypertensive mesencephalic hemorrhage (symptoms for 1 year) 2. Pontomesencephalic AVM hemorrhage (symptoms for 2 years) | 2 patients with contralateral VIM | Good tremor suppression, whereas the other symptoms remained unchanged | 7 years and 6 years respectively |
| Issar et al. 201318 | 1 patient with post-traumatic tremor (symptoms for 6 months) with associated dystonia, cerebellar and cognitive difficulties. | Bilateral VIM | Moderate partial benefit (CGI scale 3). No TRS available | N/A |
| Follett et al.9 | Post-traumatic HT (symptoms for 15 years) | Bilateral VIM | Reduction of tremor from a score of 3 to a score of 1 in the right arm and from 3.5 to 0 in the left arm (TETRAS scale) | 12 months |
| Espinoza-Martinez et al.5 | 1 patient with ICH due to cavernous malformations, 1 patient with cerebral infarction, 1 patient with MS | 1 patient with bilateral VIM (MS case) and 2 patients with unilateral VIM | 83.3% mean improvement in TRS | Mean length of follow-up 7.3 years |
| Studies reporting other DBS targets for HT | ||||
| Bandt et al. 200819 | Left midbrain cerebral infarction (symptoms for 7 months) | Left lenticular fasciculus | Almost complete resolution of postural and intention tremors; scored 1/4 on the WHIGET | 16 months |
| Plaha et al. 200820 | No obvious MRI abnormality (symptoms for 6 years) | Caudal Zi | 70.2% improvement in total TRS | N/A |
| Kilbane et al.8 | 1. Multicystic brainstem tegmentum lesions2. Right thalamic/subthalamic infarction | 2 Patient received unilateral Gpi. | 81% improvement in TRS | Mean length of follow-up 27 months |
| Espinoza-Martinez et al.5 | 3. patients with cerebral infarction, 3 patients with ICH and 1 patient with MS. | 6 patients with unilateral Gpi, 1 patient with bilateral Gpi (MS case). | 78% mean modified TRS improvement | Mean length of follow-up 5.1 years |
| Studies reporting dual or multiple DBS leads for HT | ||||
| Romanelli et al. 200321 | Unknown, severe symptoms 6 years | Left VIM and left STN | Tremor component improved 66% | 2 years |
| Foote et al.11 | Post-traumatic tremors3 patients with symptoms for 16 years, 3 years, 4 years | 2 patients with VIM (border VIM/Vop and 1 with border Voa/Vop) | Total TRS improvement of 38.46%, 48.33% and 66.67% respectively | 12 months, 6 months and 8 months respectively |
| Grabska et al.10 | Ischemic left thalamic stroke (symptoms 30 years) | Contralateral Voa and Zi | TRS 73% reduction in tremor | 4 years |
| Kobayashi et al.22 | 1. Brainstem thalamus hemorrhage (symptoms for 6 years)2. Cerebral infarction (symptoms for 3 years)3. Intracerebral midbrain hemorrhage (symptoms 8 months4. Posttraumatic (symptoms for 2 years) | 4 patients with dual-lead stimulation of ventralis oralis/ventralis intermedius nuclei (VO/VIM) and PSA | 87% mean improvement in tremor | 25 months |
| Kilbane et al.8 | 1. Right Brainstem hemorrhage due to cavernous malformation2. Left thalamic midbrain bullet fragment | Patient 1 had VIM/Voa and Gpi leads. Patient 2 had VIM/Gpi leads | 77.5% improvement in TRS. VIM or combined stimulation was not superior to Gpi lead (only lead active) | Mean length of follow-up 40 months |
[i] Abbreviations: Gpi, Globus Pallidus Interna; ICH, Intracranial Hemorrhage; MS, Multiple Sclerosis; MRI, Magnetic Resonance Imaging; PSA, Posterior Subthalamic Area; STN, Subthalamic Nucleus; TETRAS, The Essential Tremor Rating Assessment Scale; TRS, Tremor Rating Scale; VIM, Ventral Intermedius Nucleus; Voa, Ventralis Oralis Anterior Nucleus; Vop, Ventralis Oralis Posterior Nucleus; VO, ventralis oralis; WHIGET, Washington HeightsInwood Genetic Study of Essential Tremor; Zi, Zona Incerta; AVM, arteriovenous malformation
Figure 1
Axial (left) and sagittal (middle) T1 weighted MRI with gadolinium, and sagittal CT scan (right) of unsecured AV fistula.
Figure 2
Sample LFP spectrograms in GPI (action) (A) and GPE (B). Corresponding GPI (C) and GPE (D) power spectral densities are included. Brackets (A-D): Δ, delta (0–3Hz); θ, theta (4-7 Hz); α, alpha (8–12Hz); Lβ, low beta (13–20Hz); Hβ, high beta (21–29Hz); γ, gamma (30-200Hz). Mean PSD values (± SEM) for each spectral band for GPI (action) (E), GPI (rest) (F) and GPE (G) are shown.
