title: Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson's disease.
abstract: Deep brain stimulation (DBS) in the thalamic ventral intermediate (Vim) or the subthalamic nucleus (STN) reportedly improves medication-refractory Parkinson's disease (PD) tremor. However, little is known about the potential synergic effects of combined Vim and STN DBS. We describe a 79-year-old man with medication-refractory tremor-dominant PD. Bilateral Vim DBS electrode implantation produced insufficient improvement. Therefore, the patient underwent additional unilateral left-sided STN DBS. Whereas Vim or STN stimulation alone led to partial improvement, persisting tremor resolution occurred after simultaneous stimulation. The combination of both targets may have a synergic effect and is an alternative option in suitable cases.
authors.affiliation: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland. markus.oertel@insel.ch.
authors.forename: Markus F
authors.initials: MF
authors.lastname: Oertel
authors.affiliation: Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: W Michael M
authors.initials: WM
authors.lastname: Schüpbach
authors.affiliation: Department of Neurology, Hôpital du Valais, Sion, Switzerland.
authors.forename: Joseph-André
authors.initials: JA
authors.lastname: Ghika
authors.affiliation: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.|Department of Neurosurgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Lennart H
authors.initials: LH
authors.lastname: Stieglitz
authors.affiliation: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Fiechter
authors.affiliation: Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.|Neurocenter of Southern Switzerland, Lugano, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Kaelin-Lang
authors.affiliation: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
authors.affiliation: Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pollo
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D020531:Subthalamic Nucleus; D014202:Tremor / Q000209:etiology / Q000628:therapy*; D020651:Ventral Thalamic Nuclei
keywords: Deep brain stimulation; Parkinson’s disease; Subthalamic nucleus; Thalamic ventral intermediate nucleus; Tremor