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Deep Brain Stimulation of the Caudal Zona Incerta and Motor Thalamus for Postischemic Dystonic Tremor of the Left Upper Limb: Case Report and Review of the Literature.
World Neurosurg. 2019 05; 125:191-197.WN

Abstract

BACKGROUND

Dystonic tremor is defined as a tremor occurring in a body region affected by dystonia. The pathophysiologic mechanisms behind dystonic tremor supposedly involve anomalies affecting the pallidothalamic-receiving area (for the dystonic component) and the ventralis intermedius-cortical loop (for the tremor component). Interest in posterior subthalamic area stimulation for various types of involuntary abnormal movements has arisen owing to positive results in patients affected by tremor refractory to ventralis intermedius deep brain stimulation.

CASE DESCRIPTION

A 23-year-old man, with a 15-year history of left upper limb dystonic tremor due to a stroke in the right thalamus, underwent deep brain stimulation with a single electrode passing through the right ventralis oralis anterior/ventralis oralis posterior nuclei and caudal zona incerta. Objective movement outcomes were assessed through the Unified Dystonia Rating Scale and Fahn-Tolosa-Marin Clinical Rating Scale for Tremor. The impact of tremor on activities of daily living was assessed with the ADL-T24 questionnaire, and quality of life was assessed with the Quality of Life Scale. All questionnaires were administered before deep brain stimulation and at 5-year follow-up. Unified Dystonia Rating Scale and Fahn-Tolosa-Marin Clinical Rating Scale for Tremor scores decreased from 14.5 to 4.5 and from 46 to 7, respectively. ADL-T24 score decreased from 19 to 3, whereas Quality of Life Scale score increased from 49 to 82.

CONCLUSIONS

Stimulation of motor thalamus and caudal zona incerta could be a viable treatment for patients affected by tremor of various origins, including dystonic tremor, refractory to medical therapy.

Authors+Show Affiliations

University of Milan, Faculty of Medicine, Milan, Italy. Electronic address: davide.bagatti@libero.it.Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

30738935

Citation

Bagatti, Davide, et al. "Deep Brain Stimulation of the Caudal Zona Incerta and Motor Thalamus for Postischemic Dystonic Tremor of the Left Upper Limb: Case Report and Review of the Literature." World Neurosurgery, vol. 125, 2019, pp. 191-197.
Bagatti D, D'Ammando A, Franzini A, et al. Deep Brain Stimulation of the Caudal Zona Incerta and Motor Thalamus for Postischemic Dystonic Tremor of the Left Upper Limb: Case Report and Review of the Literature. World Neurosurg. 2019;125:191-197.
Bagatti, D., D'Ammando, A., Franzini, A., & Messina, G. (2019). Deep Brain Stimulation of the Caudal Zona Incerta and Motor Thalamus for Postischemic Dystonic Tremor of the Left Upper Limb: Case Report and Review of the Literature. World Neurosurgery, 125, 191-197. https://doi.org/10.1016/j.wneu.2019.01.183
Bagatti D, et al. Deep Brain Stimulation of the Caudal Zona Incerta and Motor Thalamus for Postischemic Dystonic Tremor of the Left Upper Limb: Case Report and Review of the Literature. World Neurosurg. 2019;125:191-197. PubMed PMID: 30738935.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep Brain Stimulation of the Caudal Zona Incerta and Motor Thalamus for Postischemic Dystonic Tremor of the Left Upper Limb: Case Report and Review of the Literature. AU - Bagatti,Davide, AU - D'Ammando,Antonio, AU - Franzini,Angelo, AU - Messina,Giuseppe, Y1 - 2019/02/08/ PY - 2018/11/21/received PY - 2019/01/21/revised PY - 2019/01/22/accepted PY - 2019/2/11/pubmed PY - 2019/11/5/medline PY - 2019/2/11/entrez KW - DBS KW - Dystonic tremor KW - Motor thalamus KW - Single electrode KW - Zona incerta SP - 191 EP - 197 JF - World neurosurgery JO - World Neurosurg VL - 125 N2 - BACKGROUND: Dystonic tremor is defined as a tremor occurring in a body region affected by dystonia. The pathophysiologic mechanisms behind dystonic tremor supposedly involve anomalies affecting the pallidothalamic-receiving area (for the dystonic component) and the ventralis intermedius-cortical loop (for the tremor component). Interest in posterior subthalamic area stimulation for various types of involuntary abnormal movements has arisen owing to positive results in patients affected by tremor refractory to ventralis intermedius deep brain stimulation. CASE DESCRIPTION: A 23-year-old man, with a 15-year history of left upper limb dystonic tremor due to a stroke in the right thalamus, underwent deep brain stimulation with a single electrode passing through the right ventralis oralis anterior/ventralis oralis posterior nuclei and caudal zona incerta. Objective movement outcomes were assessed through the Unified Dystonia Rating Scale and Fahn-Tolosa-Marin Clinical Rating Scale for Tremor. The impact of tremor on activities of daily living was assessed with the ADL-T24 questionnaire, and quality of life was assessed with the Quality of Life Scale. All questionnaires were administered before deep brain stimulation and at 5-year follow-up. Unified Dystonia Rating Scale and Fahn-Tolosa-Marin Clinical Rating Scale for Tremor scores decreased from 14.5 to 4.5 and from 46 to 7, respectively. ADL-T24 score decreased from 19 to 3, whereas Quality of Life Scale score increased from 49 to 82. CONCLUSIONS: Stimulation of motor thalamus and caudal zona incerta could be a viable treatment for patients affected by tremor of various origins, including dystonic tremor, refractory to medical therapy. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30738935/Deep_Brain_Stimulation_of_the_Caudal_Zona_Incerta_and_Motor_Thalamus_for_Postischemic_Dystonic_Tremor_of_the_Left_Upper_Limb:_Case_Report_and_Review_of_the_Literature_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)30294-3 DB - PRIME DP - Unbound Medicine ER -