title: Treating post-traumatic tremor with deep brain stimulation: report of five cases.
abstract: BACKGROUND
  Post-traumatic tremor is one of the most common movement disorders resulting from severe head trauma. However, literature regarding successful deep brain stimulation (DBS) treatment is scarce, resulting in ambiguity regarding the optimal lead location. Most cases support the ventral intermediate nucleus, but there is evidence to defend DBS of the zona incerta, ventral oralis anterior/posterior, and/or a combination of these targets. We report five patients with disabling post-traumatic tremor treated with DBS of the ventral intermediate nucleus and of the globus pallidus internus.
  
  
  METHODS
  Patients were referred to the Vanderbilt Movement Disorders Division, and surgical intervention was determined by a DBS Multidisciplinary Committee. Standard DBS procedure was followed.
  
  
  RESULTS
  Patients 1-4 sustained severe diffuse axonal injuries. Patients 1-3 underwent unilateral ventral intermediate nucleus DBS for contralateral tremor, while Patient 4 underwent bilateral ventral intermediate nucleus DBS. Patients 1-3 experienced good tremor reduction, while Patient 4 experienced moderate tremor reduction with some dystonic posturing of the hands. Patient 5 had dystonic posturing of the right upper extremity with tremor of the left upper extremity. He was treated with bilateral DBS of the globus pallidus internus and showed good tremor reduction at follow-up.
  
  
  CONCLUSIONS
  Unilateral or bilateral DBS of the ventral intermediate nucleus and bilateral DBS of the globus pallidus internus may be effective and safe treatment modalities for intractable post-traumatic tremor. Further studies are needed to clarify the optimal target for surgical treatment of post-traumatic tremor.
authors: School of Medicine, Vanderbilt University, Nashville, TN, USA.
authors: Neil M
authors: NM
authors: Issar
authors: Peter
authors: P
authors: Hedera
authors: Fenna T
authors: FT
authors: Phibbs
authors: Peter E
authors: PE
authors: Konrad
authors: Joseph S
authors: JS
authors: Neimat
mesh_terms: D000293:Adolescent; D000328:Adult; D006259:Craniocerebral Trauma / Q000150:complications*; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014202:Tremor / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
keywords: Deep brain stimulation; Globus pallidus internus; Post-traumatic; Tremor; Ventral intermediate nucleus