Objective tremor registration during DBS surgery for essential tremor.
Essential Tremor (ET) is characterized by a 4-12-Hz postural and kinetic tremor, most commonly affecting the upper limbs. Deep brain stimulation (DBS) of the thalamus (Vim) has been found to be highly effective in severe/refractory forms of ET. Intra-operative assessment of tremor is performed using clinical methods based on patient and physician perception of tremor intensity. We present for the first time the case of a patient whose tremor was objectively monitored/quantified pre- and intra-operatively using device-based tremor registration to supplement clinical measures. We present the case of a 76-year-old right-handed woman that received unilateral (left-sided) DBS of the ventrointermediate (Vim) nucleus of thalamus (Vim) for medically refractory ET. Tremor was monitored with an accelerometer-based Tremor Pen, which is part of a simple portable device (CATSYS 2000 System, Danish Product Development Ltd., DK, www.catsys.dk). The patient was asked to perform tasks for tremor evaluation before and during thalamic DBS. Tremor quantification revealed a significant improvement (34.7-fold) in the contralateral (right) limb following macro-stimulation. No significant improvement was registered in the ipsilateral (non-operated) side. Simple electronic tremor registration methods during DBS of the Vim nucleus of the thalamus may supplement the existing methodology that is solely based on subjective measures derived from clinical observations.
Papapetropoulos
Spiridon
S
Division of Movement Disorders, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL 33136, United States. spapapetropoulos@med.miami.edu
Gallo
Bruno V
BV
Guevara
Alexandra
A
Singer
Carlos
C
Mitsi
Georgia
G
Lyssikatos
Charalampos
C
Jagid
Jonathan R
JR
D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004576:Electromyography; D020329:Essential Tremor / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D013788:Thalamus / Q000503:physiopathology*; D016896:Treatment Outcome; D014202:Tremor / Q000628:therapy