Biomaterial Database

Deep Brain Stimulation Management of Essential Tremor with Dystonic Features. 2018

Amar Patel, and Wissam Deeb, and Michael S Okun

Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.

A 64-year-old female with essential tremor (ET) presents for evaluation of deep brain stimulation (DBS) candidacy. Examination revealed subtle dystonic features as well as a disabling postural-action tremor. Can dystonia occur in the setting of the diagnosis of ET and can its presence alter DBS target selection? Unilateral DBS implantation of the ventralis intermedius (Vim) led to improvement in both tremor and dystonic posturing. Case reports of DBS in dystonic tremor suggest Vim, globus pallidus internus (GPi), and subthalamic targets may all be effective, to varying degrees, in improving both tremor and dystonia. More rigorous studies are needed to identify the optimal target(s). This case underscores the limited evidence available to guide a clinician's choice of DBS targets in patients with ET and dystonia. The severity of the dystonia and the presence of more generalized dystonia may alter the thinking about optimal targeting. Vim, GPi, and subthalamic targets appear potentially acceptable options, though Vim is usually the first target attempted when postural-action tremor is the chief complaint. Occasionally, a second rescue DBS lead may be necessary.

UI	MeSH Term	Description	Entries
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D004421	Dystonia	An attitude or posture due to the co-contraction of agonists and antagonist muscles in one region of the body. It most often affects the large axial muscles of the trunk and limb girdles. Conditions which feature persistent or recurrent episodes of dystonia as a primary manifestation of disease are referred to as DYSTONIC DISORDERS. (Adams et al., Principles of Neurology, 6th ed, p77)	Muscle Dystonia,Dystonia, Diurnal,Dystonia, Limb,Dystonia, Paroxysmal,Diurnal Dystonia,Dystonia, Muscle,Limb Dystonia,Paroxysmal Dystonia
D005260	Female		Females
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D046690	Deep Brain Stimulation	Therapy for MOVEMENT DISORDERS, especially PARKINSON DISEASE, that applies electricity via stereotactic implantation of ELECTRODES in specific areas of the BRAIN such as the THALAMUS. The electrodes are attached to a neurostimulator placed subcutaneously.	Brain Stimulation, Deep,Electrical Stimulation of the Brain,Brain Stimulations, Deep,Deep Brain Stimulations,Stimulation, Deep Brain,Stimulations, Deep Brain
D020329	Essential Tremor	A relatively common disorder characterized by a fairly specific pattern of tremors which are most prominent in the upper extremities and neck, inducing titubations of the head. The tremor is usually mild, but when severe may be disabling. An autosomal dominant pattern of inheritance may occur in some families (i.e., familial tremor). (Mov Disord 1988;13(1):5-10)	Benign Essential Tremor,Familial Tremor,Hereditary Essential Tremor,Benign Essential Tremors,Essential Tremor, Benign,Essential Tremors,Essential Tremors, Benign,Familial Tremors,Tremor, Benign Essential,Tremor, Essential,Tremor, Familial,Tremors, Benign Essential,Tremors, Essential,Tremors, Familial
D020651	Ventral Thalamic Nuclei	A large group of nuclei lying between the internal medullary lamina and the INTERNAL CAPSULE. It includes the ventral anterior, ventral lateral, and ventral posterior nuclei.	Ventral Anterior Thalamic Nucleus,Ventral Lateral Thalamic Nucleus,Ventral Nuclear Group,Ventral Posterior Inferior Thalamic Nucleus,Ventral Posterior Thalamic Nucleus,Ventral Posterolateral Thalamic Nucleus,Ventral Posteromedial Thalamic Nucleus,Arcuate Nucleus-3,Nucleus Ventralis Intermedius,Nucleus Ventralis Lateralis,Nucleus Ventralis Posterior,Nucleus Ventralis Posterolateralis,Nucleus Ventralis Posteromedialis,Nucleus Ventrolateralis Thalami,Ventral Anterior Nucleus,Ventral Lateral Nucleus,Ventral Lateral Thalamic Nuclei,Ventral Nuclear Mass,Ventral Nuclei of Thalamus,Ventral Posterior Inferior Nucleus,Ventral Posterior Medial Nucleus,Ventral Posterior Nucleus,Ventral Posteroinferior Nucleus,Ventral Posterolateral Nucleus,Ventral Posteromedial Nucleus,Ventrobasal Complex,Ventrolateral Thalamic Nucleus,Ventrolateral Thalamus,Arcuate Nucleus 3,Complex, Ventrobasal,Complices, Ventrobasal,Group, Ventral Nuclear,Intermedius, Nucleus Ventralis,Laterali, Nucleus Ventralis,Lateralis, Nucleus Ventralis,Mass, Ventral Nuclear,Masses, Ventral Nuclear,Nuclear Group, Ventral,Nuclear Mass, Ventral,Nuclear Masses, Ventral,Nuclei, Ventral Thalamic,Nucleus Ventralis Laterali,Nucleus Ventralis Posteriors,Nucleus Ventralis Posterolaterali,Nucleus Ventralis Posteromediali,Nucleus Ventrolateralis Thalamus,Nucleus, Ventral Anterior,Nucleus, Ventral Lateral,Nucleus, Ventral Posterior,Nucleus, Ventral Posteroinferior,Nucleus, Ventral Posterolateral,Nucleus, Ventral Posteromedial,Nucleus, Ventral Thalamic,Nucleus, Ventrolateral Thalamic,Posterior Nucleus, Ventral,Posterior, Nucleus Ventralis,Posteriors, Nucleus Ventralis,Posteroinferior Nucleus, Ventral,Posterolateral Nucleus, Ventral,Posterolaterali, Nucleus Ventralis,Posterolateralis, Nucleus Ventralis,Posteromedial Nucleus, Ventral,Posteromediali, Nucleus Ventralis,Posteromedialis, Nucleus Ventralis,Thalami, Nucleus Ventrolateralis,Thalamic Nuclei, Ventral,Thalamic Nucleus, Ventral,Thalamic Nucleus, Ventrolateral,Thalamus, Nucleus Ventrolateralis,Thalamus, Ventrolateral,Ventral Nuclear Groups,Ventral Nuclear Masses,Ventral Thalamic Nucleus,Ventralis Intermedius, Nucleus,Ventralis Laterali, Nucleus,Ventralis Lateralis, Nucleus,Ventralis Posterior, Nucleus,Ventralis Posteriors, Nucleus,Ventralis Posterolaterali, Nucleus,Ventralis Posterolateralis, Nucleus,Ventralis Posteromediali, Nucleus,Ventralis Posteromedialis, Nucleus,Ventrobasal Complices,Ventrolateralis Thalami, Nucleus,Ventrolateralis Thalamus, Nucleus