Figure 1
Axial FLAIR MRI. Chronic infarcts of the (A) right medial cerebellar peduncle and (B) bilateral thalami.
Figure 2
DaT Scan (I 123-FP CIT). The Scan Demonstrates Absent Radiotracer Activity in the Right Caudate and Putamen and Reduced Radiotracer Uptake within the Left Putamen, with Relatively Preserved Uptake in the Left Caudate.
Video 1
The Patient is Evaluated Preoperatively without Levodopa in this Video. She is then evaluated postoperatively with the DBS turned on, then turned off. Note the improvement in the amplitude of the tremor at rest, action, and posture when the DBS is turned on.
Table 1
Key Tremor Axes Analysis (Top) and Spiral Analysis (Bottom) Findings of the Left, Nondominant Hand, Pre- and Postoperatively
| Pre-DBS | Post-DBS | |
|---|---|---|
| Axes | ||
| Frequency range (in Hz) | 3.74–7.17 | 3.27–3.77 |
| Primary axes range (in degrees) | 40–115 | 50–90 |
| Tremor | ||
| Degree of Severity | 2.872 ± 0.288 | 2.678 ± 0.327 |
| Tremor frequency | 5.090 ± 0.152 | 3.506 ± 0.074 |
| Max power | 4.830 ± 1.862 | 3.909 ± 0.055 |
| Amplitude (cm) | 3.065 ± 0.861 | 4.370 ± 1.367 |
| Tightness | 0.979 ± 0.057 | 1.295 ± 0.109 |
| Width variation | 0.493 ± 0.104 | 0.497 ± 0.073 |
| Second-order smoothness | 1.873 ± 1.206 | −0.133 ± 1.631 |
[i] Abbreviation: DBS, Deep Brain Stimulation.
Note the reduction in frequency range in the axes analysis. Also note the reduction in tremor power and Degree of Severity (DoS) postoperatively, as well as the improvement in second-order smoothness (negative values indicate improved execution of spiral drawing, with the normal value being −4.19). Spiral loop width variability is indicated by “width variation” is indicative of cerebellar dysfunction and did not significantly change postoperatively.
Figure 3
Axes Analysis: (A) Preoperatively and (B) Postoperatively. Note the reduction in number and range of tremor axes.
Figure 4
Tremor Analysis Spirals of the Left, Nondominant Hand. (A) Preoperative and (B) Postoperative Spirals.