Long-term deep brain stimulation in a patient with essential tremor: clinical response and postmortem correlation with stimulator termination sites in ventral thalamus. Case report.
Essential tremor can be suppressed with chronic, bilateral deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim), the cerebellar receiving area of the motor thalamus. The goal in this study was to correlate the location of the electrodes with the clinical efficacy of DBS in a patient with essential tremor. The authors report on a woman with essential tremor in whom chronic bilateral DBS directed to the ventral thalamus produced adequate tremor suppression until her death from unrelated causes 16 months after placement of the electrodes. Neuropathological postmortem studies of the brain in this patient demonstrated that both stimulators terminated in the Vim region of the thalamus, and that chronic DBS elicited minor reactive changes confined to the immediate vicinity of the electrode tracks. Although the authors could not identify neuropathological abnormalities specific to essential tremor, they believe that suppression of essential tremor by chronic DBS correlates with bilateral termination of the stimulators in the Vim region of the thalamus.
Boockvar
J A
JA
Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, USA. boockvar@mail.med.upenn.edu
Telfeian
A
A
Baltuch
G H
GH
Skolnick
B
B
Simuni
T
T
Stern
M
M
Schmidt
M L
ML
Trojanowski
J Q
JQ
D001931:Brain Mapping; D004292:Dominance, Cerebral / Q000502:physiology; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004567:Electrodes, Implanted; D020329:Essential Tremor / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005911:Gliosis / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009474:Neurons / Q000473:pathology; D020651:Ventral Thalamic Nuclei / Q000473:pathology / Q000503:physiopathology*