Video 1
Pre-surgical Evaluation Showed a Postural, Kinetic, and Intention Tremor in Both Hands, Left Greater than Right. With the hands outstretched there was mild dystonic posturing of the digits.
Video 2
Six-month Post-surgical Evaluation, with Significant Improvement in the Left Hand Tremor and Dystonia. Right ventralis intermedius targeting coordinates 14 mm lateral and 5.5 mm anterior from the posterior commissure (PC) with the z-axis at the anterior commissure-posterior commissure (ACPC) plane. Programming settings: contacts 9+, 10−, 11+; 3.7 V; 120 us; 180 Hz.
Figure 1
Spiral Drawing. Left hand spiral drawing pre (left) and post (right) ventralis intermedius deep brain stimulation surgery.
Table 1
Summary of Studies Commenting Specifically on Tremor Improvement in Dystonia Treated with Deep Brain Stimulation
| Study | N | Diagnosis | DBS Target | Outcome |
|---|---|---|---|---|
| Kitagawa et al.19 | 1 | ET/DT | cZi | “Remarkably reduced” tremor and also “reduced” dystonia |
| Vercueil et al.13 | 19 | Primary and secondary limb tremor and dystonia | 9 Vim 3 Vim and GPi 7 GPi | “Satisfactory” outcome (global functional score of 2 or 3) in Vim leads 6/12 (50%) GPi leads 7/10 (70%) |
| Chou et al.17 | 1 | Segmental dystonia and ET | STN | TWSTRS OFF/ON stimulation (14/3) with “full tremor suppression” |
| Plaha et al.20 | 1 | DT | cZi | 65% improvement in BFMDRS and 70.5% in FTM-TRS |
| Blomstedt et al.21 | 2 | DT | PSA | Patient 1 TRS subscores: Pre-surgical 9 Post-surgical OFF-stim 3 Post-surgical ON-stim 0 with “no dystonic posturing” Patient 2 TRS subscores: Pre-surgical 20 Post-surgical OFF-stim 0 (IPG subsequently removed) |
| Morishita et al.15 | 3 | 1. Generalized dystonia with head and hand tremor (prior GPi DBS) 2. Postural and intention hand tremor with dystonic posture 3. Cervical dystonia with head tremor and bilateral hand tremor | Vim | 1. TRS OFF-stim 40, ON-stim 22 2. TRS OFF-stim 43, ON-stim 21 3. TRS OFF stim 24, ON-stim 17 |
| Hedera et al.14 | 10 | 6 generalized dystonia 3 hemi-dystonia 1 segmental dystonia | 3 Unilateral Vim 1 Bilateral Vim 4 Bilateral GPi 2 Bilateral GPi and unilateral Vim | Vim DBS – 84.7% improvement in WHIGET, no change in BFMDRSGPi DBS – 39.8% improvement in WHIGET, 63.5% improvement in BFMDRS |
| Ramirez et al.16 | 2 | DT | Unilateral GPi Bilateral GPi | 82% improvement in post-surgical FTM-TRS 79% improvement in FTM-TRS |
[i] Abbreviations: BFMDRS, Burke–Fahn–Marsden Dystonia Rating Scale; cZi, Caudal Zona Incerta; DT, Dystonic Tremor; ET, Essential Tremor; FTM-TRS, Fahn–Tolosa–Marin Tremor Rating Scale; GPi, Globus Pallidus Internus; IPG, Implanted Pulse Generator; PSA, Posterior Subthalamic Area; STN, Subthalamic Nucleus; TWSTRS, Toronto Western Spasmodic Torticollis Scale; Vim, Thalamic Ventralis Intermedius; WHIGET, Washington Heights–Inwood Genetic Study of Essential Tremor.