Abstract Details

Title Treatment of Medication-Refectory Holmes Tremor by Simultaneous Thalamic Ventral Intermediate (VIM) Nucleus and Subthalamic Nucleus (STN) Deep Brain Stimulation-A Case Report

Topic Movement Disorders

Presentation(s) P14 - Poster Session 14 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-017

Objective To report a case of medication refractory Holmes Tremor in a patient with pontine stroke and multisystem atrophy-cerebellar type (MSA-C) successfully treated with bilateral, simultaneous VIM and STN deep brain stimulation by Boston Scientific non-directional lead with 8-contacts.

Background Holmes tremor has resting, postural and kinetic components which are often disabling and medication refractory. Cerebello-thalamic and dopaminergic-igrostriatal circuits are thought to have role in its causation. VIM, globus pallidus pars interna, and/or STN have been effectively used typically requiring stimulation parameters higher than in Parkinson’s disease and Essential Tremor. Dividing stimulation in target areas may require lesser stimulation, lesser power consumption and hence improve battery life.

Design/Methods Pre-surgical evaluation, surgical implantation of DBS and DBS programming sessions.

Results A 64 years old right-handed male with history of pontine stroke and MSA-C with medication refractory Holmes Tremor right > left underwent bilateral Boston Scientific non-directional 8-contact lead placement in bilateral VIM and STN. Electrode placement was confirmed by intra-operative electrophysiologic mapping and pre/post-operative imaging studies. After three DBS programming sessions patient had excellent improvement of his kinetic, postural and resting tremors. His most recent DBS settings on Left VIM/STN were Case+ 5-(10%) 6-(80%) 7-(10%); Amplitude 2.7 milliamps, pulse width 60 microseconds and frequency 130 Hertz and on right VIM/STN were Case+ 14-(70%) 13-(30%); amplitude 1.7 milliamps, pulse width 60 microseconds and frequency 130 Hertz. Post DBS programming patient was able to carry all his activities of daily living and hence significantly improved his quality of life.

Conclusions Both VIM and STN are effective targets for DBS in medication-refractory Holmes Tremor. Simultaneous stimulation of both targets and dividing stimulation in terms of percentage in both targets helped achieve excellent clinical response with lower needed stimulation parameters than expected. This could lead to lesser battery consumption and less frequent battery replacement while maintaining excellent clinical response.

Authors/Disclosures
Muhammad W. Anjum, MD (LSUHSC-S Department of Neurology) PRESENTER	Dr. Anjum has nothing to disclose.
	No disclosure on file
Yasar A. Torres-Yaghi, MD	Dr. Torres-Yaghi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Acorda. Dr. Torres-Yaghi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Dr. Torres-Yaghi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amneal. Dr. Torres-Yaghi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbott. Dr. Torres-Yaghi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Kyowa Kirin. Dr. Torres-Yaghi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Teva. Dr. Torres-Yaghi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sunovion .
Amelia Carwin, MD (SCL Health)	Dr. Carwin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acadia. Dr. Carwin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyowa Kirin.
Fernando L. Pagan, MD, F�鶹��ýӳ�� (Georgetown University Hospital Dept of Neurology)	Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Acorda. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Adamas. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merz. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Kyowa Kirin. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sunovion. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for US World Meds. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Supernus. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Acorda. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Adamas. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amneal. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sunovion. Dr. Pagan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurocrine. Dr. Pagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sunovion. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Supernus. Dr. Pagan has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Parkinsonism and related Disorders. Dr. Pagan has stock in Keiferx. The institution of Dr. Pagan has received research support from US World Meds. The institution of Dr. Pagan has received research support from Novartis.

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