title: Deep brain stimulation for vocal tremor: a comprehensive, multidisciplinary methodology.
abstract: Tremulous voice is a characteristic feature of a multitude of movement disorders, but when it occurs in individuals diagnosed with essential tremor, it is referred to as essential vocal tremor (EVT). For individuals with EVT, their tremulous voice is associated with significant social embarrassment and in severe cases may result in the discontinuation of employment and hobbies. Management of EVT is extremely difficult, and current behavioral and medical interventions for vocal tremor result in suboptimal outcomes. Deep brain stimulation (DBS) has been proposed as a potential therapeutic avenue for EVT, but few studies can be identified that have systematically examined improvements in EVT following DBS. The authors describe a case of awake bilateral DBS targeting the ventral intermediate nucleus for a patient suffering from severe voice and arm tremor. They also present their comprehensive, multidisciplinary methodology for definitive treatment of EVT via DBS. To the authors' knowledge, this is the first time comprehensive intraoperative voice evaluation has been used to guide microelectrode/stimulator placement, as well as the first time that standard pre- and post-DBS assessments have been conducted, demonstrating the efficacy of this tailored DBS approach.
authors.affiliation: Departments of 1Neurosurgery and.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Ho
authors.affiliation: 2Otolaryngology (Head and Neck Surgery), Stanford University School of Medicine, Stanford, California.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Erickson-Direnzo
authors.affiliation: Departments of 1Neurosurgery and.
authors.forename: Arjun V
authors.initials: AV
authors.lastname: Pendharkar
authors.affiliation: 2Otolaryngology (Head and Neck Surgery), Stanford University School of Medicine, Stanford, California.
authors.forename: Chih-Kwang
authors.initials: CK
authors.lastname: Sung
authors.affiliation: Departments of 1Neurosurgery and.
authors.forename: Casey H
authors.initials: CH
authors.lastname: Halpern
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D014202:Tremor / Q000150:complications / Q000628:therapy*; D064706:Vocal Cord Dysfunction / Q000209:etiology / Q000628:therapy*; D014831:Voice / Q000502:physiology*
keywords: AC-PC = anterior commissure-posterior commissure; DBS = deep brain stimulation; EVT = essential vocal tremor; FO = fundamental frequency; PD = Parkinson’s disease; STN = subthalamic nucleus; Vim = ventral intermediate nucleus; deep brain stimulation; dysphonia; essential tremor; essential vocal tremor; ventral intermediate nucleus