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Published in: Child's Nervous System 9/2008

01-09-2008 | Case Report

Deep brain stimulation for Holmes’ tremor related to a thalamic abscess

Authors: Selcuk Peker, Ugur Isik, Yasemin Akgun, Memet Ozek

Published in: Child's Nervous System | Issue 9/2008

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Abstract

Background

Medical treatment is usually ineffective for Holmes’ tremor, and surgery is the treatment of choice for many patients. Here we report the case of a 14-year-old girl who developed Holmes’ tremor related to a thalamic abscess and was successfully treated with thalamic deep brain stimulation.

Case report

The patient presented with left hemiparesis and headache and was hospitalized. Investigation revealed a thalamic abscess in the left cerebral hemisphere. The abscess was drained via stereotactic surgery and a course of antibiotic treatment was completed. Four months after treatment, the patient developed Holmes’ tremor in her left upper extremity. When attempts at medical treatment with levodopa, clonazepam, and trihexyphenidyl all failed, an implant was placed and deep brain stimulation of the ventral intermediate nucleus of the thalamus was initiated. During 2.5 years of follow-up, her tremor diminished by 90%.

Conclusion

This case demonstrates that medically resistant Holmes’ tremor related to a thalamic lesion can be successfully treated with thalamic deep brain stimulation.
Literature
1.
go back to reference Akkus DE, Diramali AB (2006) Postichemic delayed Holmes’ tremor responding to low-dose cabergoline. Mov Disord 21:733–734PubMedCrossRef Akkus DE, Diramali AB (2006) Postichemic delayed Holmes’ tremor responding to low-dose cabergoline. Mov Disord 21:733–734PubMedCrossRef
2.
go back to reference Deusch G, Bain P, Brin M (1998) Consensus statement of the Movement Disorder Society on tremor. Ad hoc scientific committee. Mov Disord 13(Suppl 3):2–23 Deusch G, Bain P, Brin M (1998) Consensus statement of the Movement Disorder Society on tremor. Ad hoc scientific committee. Mov Disord 13(Suppl 3):2–23
3.
go back to reference Filali M, Hutchinson WD, Palter VN, Lozano AM, Dostrovsky JO (2004) Stimulation-induced inhibition of neuronal firing in human subthalaic nucleus. Exp Brain Res 156:274–281PubMedCrossRef Filali M, Hutchinson WD, Palter VN, Lozano AM, Dostrovsky JO (2004) Stimulation-induced inhibition of neuronal firing in human subthalaic nucleus. Exp Brain Res 156:274–281PubMedCrossRef
4.
go back to reference Foote KD, Okun MS (2005) Ventralis intermedius plus ventralis oralis anterior and posterior deep brain stimulation for posttraumatic Holmes tremor: two leads may be better than one. Neurosurgery 56(ONS Suppl 2):ONS-445 Foote KD, Okun MS (2005) Ventralis intermedius plus ventralis oralis anterior and posterior deep brain stimulation for posttraumatic Holmes tremor: two leads may be better than one. Neurosurgery 56(ONS Suppl 2):ONS-445
5.
go back to reference Foote KD, Seignourel P, Fernandez HH, Romrell J, Whidden E, Jacobson C, Rodriguez RL, Okun MS (2006) Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor. Neurosurg 58(ONS Suppl 2):ONS-280-ONS-286CrossRef Foote KD, Seignourel P, Fernandez HH, Romrell J, Whidden E, Jacobson C, Rodriguez RL, Okun MS (2006) Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor. Neurosurg 58(ONS Suppl 2):ONS-280-ONS-286CrossRef
6.
go back to reference Goldman MS, Kelly PJ (1992) Symptomatic and functional outcome of stereotactic ventralis lateralis thalamotomy for intention tremor. J Neurosurg 77:223–229PubMed Goldman MS, Kelly PJ (1992) Symptomatic and functional outcome of stereotactic ventralis lateralis thalamotomy for intention tremor. J Neurosurg 77:223–229PubMed
7.
go back to reference Goto S, Yamada K (2004) Combination of thalamic Vim stimulation and Gpi pallidotomy synergistically abolishes Holmes’ tremor. J Neurol Neurosurg Psychiatry 75:1200–1207CrossRef Goto S, Yamada K (2004) Combination of thalamic Vim stimulation and Gpi pallidotomy synergistically abolishes Holmes’ tremor. J Neurol Neurosurg Psychiatry 75:1200–1207CrossRef
8.
go back to reference Hertel F, Züchner M, Decker C, Erken E, Libri S, Schmitt M, Bettag M (2006) Unilateral Holmes tremor, clearly responsive to cerebrospinal fluid release, in a patient with an ischemic midbrain lesion and associated chronic hydrocephalic ventricle enlargement. J Neurosurg 104:448–451PubMedCrossRef Hertel F, Züchner M, Decker C, Erken E, Libri S, Schmitt M, Bettag M (2006) Unilateral Holmes tremor, clearly responsive to cerebrospinal fluid release, in a patient with an ischemic midbrain lesion and associated chronic hydrocephalic ventricle enlargement. J Neurosurg 104:448–451PubMedCrossRef
9.
go back to reference Holmes G (1904) On certain tremors in organic cerebral lesions. Brain 27:327–375CrossRef Holmes G (1904) On certain tremors in organic cerebral lesions. Brain 27:327–375CrossRef
10.
go back to reference Hubble JP, Busenbark KL, Wilkinson S, Pahwa R, Paulson GW, Lyons K, Koller WC (1997) Effects of thalamic deep brain stimulation based on tremor type and diagnosis. Mov Disord 12:337–341PubMedCrossRef Hubble JP, Busenbark KL, Wilkinson S, Pahwa R, Paulson GW, Lyons K, Koller WC (1997) Effects of thalamic deep brain stimulation based on tremor type and diagnosis. Mov Disord 12:337–341PubMedCrossRef
11.
go back to reference Kim MC, Son BC, Miyagi Y, Kang JK (2002) Vim thalamotomy for Holmes’ tremor secondary to midbrain tumour. J Neurol Neurosurg Psychiatry 73:453–455PubMedCrossRef Kim MC, Son BC, Miyagi Y, Kang JK (2002) Vim thalamotomy for Holmes’ tremor secondary to midbrain tumour. J Neurol Neurosurg Psychiatry 73:453–455PubMedCrossRef
12.
go back to reference Kitagawa M, Murata J, Kikuchi S, Sawamura Y, Saito H, Sasaki H, Tashiro K (2000) Deep brain stimulation of subthalamic area for severe proximal tremor. Neurology 55:114–116PubMed Kitagawa M, Murata J, Kikuchi S, Sawamura Y, Saito H, Sasaki H, Tashiro K (2000) Deep brain stimulation of subthalamic area for severe proximal tremor. Neurology 55:114–116PubMed
13.
go back to reference Krack P, Deuschl G, Kaps M, Warnke P, Schneider S, Traupe H (1994) Delayed onset of “rubral tremor” 23 years after brainstem trauma. Mov Disord 9:240–242PubMedCrossRef Krack P, Deuschl G, Kaps M, Warnke P, Schneider S, Traupe H (1994) Delayed onset of “rubral tremor” 23 years after brainstem trauma. Mov Disord 9:240–242PubMedCrossRef
14.
go back to reference Krauss JK, Mohadjer M, Nobbe F, Mundinger F (1994) The treatment of posttraumatic tremor by stereotactic surgery. J Neurosurg 80:810–819PubMed Krauss JK, Mohadjer M, Nobbe F, Mundinger F (1994) The treatment of posttraumatic tremor by stereotactic surgery. J Neurosurg 80:810–819PubMed
15.
go back to reference Kudo M, Goto S, Nishikawa S, Hamasaki T, Soyama N, Ushio Y, Mita S, Hirata Y (2001) Bilateral thalamic stimulation for Holmes tremor caused by unilateral brainstem lesion. Mov Disord 16:170–174PubMedCrossRef Kudo M, Goto S, Nishikawa S, Hamasaki T, Soyama N, Ushio Y, Mita S, Hirata Y (2001) Bilateral thalamic stimulation for Holmes tremor caused by unilateral brainstem lesion. Mov Disord 16:170–174PubMedCrossRef
16.
go back to reference Lim DA, Khandhar SM, Heath S, Ostrem JL, Ringel N, Starr P (2007) Multiple target deep brain stimulation for multiple sclerosis related and poststroke Holmes’ tremor. Stereotact Funct Neurosurg 85:144–149PubMedCrossRef Lim DA, Khandhar SM, Heath S, Ostrem JL, Ringel N, Starr P (2007) Multiple target deep brain stimulation for multiple sclerosis related and poststroke Holmes’ tremor. Stereotact Funct Neurosurg 85:144–149PubMedCrossRef
17.
go back to reference Liou LM, Shih PY (2006) Successful treatment of rubral tremor by high-dose trihexyphenidyl: a case report. Kaohsiung J Med Sci 22:149–153PubMed Liou LM, Shih PY (2006) Successful treatment of rubral tremor by high-dose trihexyphenidyl: a case report. Kaohsiung J Med Sci 22:149–153PubMed
18.
go back to reference Nikkhah G, Prokop T, Hellwig B, Lücking CH, Ostertag CB (2004) Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions. J Neurosurg 100:1079–1083PubMed Nikkhah G, Prokop T, Hellwig B, Lücking CH, Ostertag CB (2004) Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions. J Neurosurg 100:1079–1083PubMed
19.
go back to reference Pahwa R, Lyons KE, Kempf L, Wilkinson SB, Koller WC (2002) Thalamic stimulation for midbrain tremor after partial hemangioma resection. Mov Disord 17:404–407PubMedCrossRef Pahwa R, Lyons KE, Kempf L, Wilkinson SB, Koller WC (2002) Thalamic stimulation for midbrain tremor after partial hemangioma resection. Mov Disord 17:404–407PubMedCrossRef
20.
go back to reference Pezzini A, Zavarise P, Palvarini L, Viale P, Oladeji O, Padovani A (2002) Holmes’ tremor following midbrain Toxoplasma abscess: clinical features and treatment of a case. Parkinsonism Relat Disord 8:177–180PubMedCrossRef Pezzini A, Zavarise P, Palvarini L, Viale P, Oladeji O, Padovani A (2002) Holmes’ tremor following midbrain Toxoplasma abscess: clinical features and treatment of a case. Parkinsonism Relat Disord 8:177–180PubMedCrossRef
21.
go back to reference Raine GB, Velez M, Pardal MF, Micheli F (2007) Holmes tremor secondary to brainstem hemorrhage responsive to levodopa: report of 2 cases. Clin Neuropharmacol 30:95–100CrossRef Raine GB, Velez M, Pardal MF, Micheli F (2007) Holmes tremor secondary to brainstem hemorrhage responsive to levodopa: report of 2 cases. Clin Neuropharmacol 30:95–100CrossRef
22.
go back to reference Romanelli P, Bronte-Stewart H, Courtney T, Heit G (2003) Possible necessity for deep brain stimulation of both the ventralis intermedius and subthalamic nuclei to resolve Holmes tremor. J Neurosurg 99:566–571PubMed Romanelli P, Bronte-Stewart H, Courtney T, Heit G (2003) Possible necessity for deep brain stimulation of both the ventralis intermedius and subthalamic nuclei to resolve Holmes tremor. J Neurosurg 99:566–571PubMed
23.
go back to reference Samadani U, Umemura A, Jaggi JL, Colcher A, Zager EL, Baltuch GH (2003) Thalamic deep brain stimulation for disabling tremor after excision of a midbrain cavernous angioma. J Neurosurg 98:888–890PubMedCrossRef Samadani U, Umemura A, Jaggi JL, Colcher A, Zager EL, Baltuch GH (2003) Thalamic deep brain stimulation for disabling tremor after excision of a midbrain cavernous angioma. J Neurosurg 98:888–890PubMedCrossRef
24.
go back to reference Shepherd GMG, Tauböll E, Bakke SJ, Nyberg-Hansen R (1997) Midbrain tremor and hypertrophic olivary degeneration after pontine hemorrhage. Mov Disord 12:432–437PubMedCrossRef Shepherd GMG, Tauböll E, Bakke SJ, Nyberg-Hansen R (1997) Midbrain tremor and hypertrophic olivary degeneration after pontine hemorrhage. Mov Disord 12:432–437PubMedCrossRef
25.
go back to reference Weng YH, Kao PF, Tsai CH, Yen TC, L CS (2000) Dopamine deficiency in rubral tremor caused by midbrain hemangioma: case report. Chang Gung Med J 23:485–491PubMed Weng YH, Kao PF, Tsai CH, Yen TC, L CS (2000) Dopamine deficiency in rubral tremor caused by midbrain hemangioma: case report. Chang Gung Med J 23:485–491PubMed
Metadata
Title
Deep brain stimulation for Holmes’ tremor related to a thalamic abscess
Authors
Selcuk Peker
Ugur Isik
Yasemin Akgun
Memet Ozek
Publication date
01-09-2008
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 9/2008
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-008-0644-2

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