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Published in: Journal of Neurology 4/2023

Open Access 21-01-2023 | Dystonia | Original Communication

DBS in tremor with dystonia: VIM, GPi or both? A review of the literature and considerations from a single-center experience

Authors: Davide Paoli, Russell Mills, Una Brechany, Nicola Pavese, Claire Nicholson

Published in: Journal of Neurology | Issue 4/2023

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Abstract

Background

Deep brain stimulation (DBS) is an established treatment for dystonia and tremor. However, there is no consensus about the best surgical targeting strategy in patients with concomitant tremor and dystonia. Both the thalamic ventral intermediate nucleus (VIM) and the globus pallidus pars interna (GPi) have been proposed as targets. Few cases using them together in a double-target approach have also been reported.

Methods

We reviewed the literature on this topic, summarizing results of different target choices. Additionally, we retrospectively report a case series of nine patients with sporadic dystonia and severe tremor treated with a double-target strategy at our center. Outcome measures were the Burke-Fahn-Marsden Dystonia Rating Scale (BFM) and Eq-5d scale.

Results

In published studies of patients with dystonia and tremor, VIM-DBS is highly effective on tremor but raise some concerns about dystonia’s control, while GPi-DBS is more effective on dystonia but does not always relieve tremor. GPi + VIM-DBS shows good efficacy but is rarely reported and reserved for selected patients. In our patients, the double-target strategy obtained a significant and durable improvement in tremor, dystonia, and quality of life. Additionally, compared with a cohort of patients with tremor treated with VIM-DBS only, significantly lower frequency and intensity of VIM stimulation were required to control tremor.

Conclusion

Our findings and published evidence seem to support the double-targeting approach as a safe and effective option in selected patients with tremor-dominant dystonia. This strategy appears to provide a more extensive control of either dystonia or tremor and may have a potential for limiting stimulation-related side effects.
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Literature
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go back to reference Schadt CR, Charles PD, Davis TL, Konrad PE (2007) Thalamotomy, DBS-Vim, and DBS-GPi for generalized dystonia: a case report. Tenn Med 100(2):38–39PubMed Schadt CR, Charles PD, Davis TL, Konrad PE (2007) Thalamotomy, DBS-Vim, and DBS-GPi for generalized dystonia: a case report. Tenn Med 100(2):38–39PubMed
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go back to reference Coenen V, Rijntjes M, Sajonz B, Piroth T, Prokop T, Jost W et al (2019) Bilateral globus pallidus internus deep brain stimulation in a case of progressive dystonia in Mohr-Tranebjaerg syndrome with bilateral cochlear implants. J Neurol Surg A Cent Eur Neurosurg 80(01):044–048. https://doi.org/10.1055/s-0038-1669472CrossRef Coenen V, Rijntjes M, Sajonz B, Piroth T, Prokop T, Jost W et al (2019) Bilateral globus pallidus internus deep brain stimulation in a case of progressive dystonia in Mohr-Tranebjaerg syndrome with bilateral cochlear implants. J Neurol Surg A Cent Eur Neurosurg 80(01):044–048. https://​doi.​org/​10.​1055/​s-0038-1669472CrossRef
Metadata
Title
DBS in tremor with dystonia: VIM, GPi or both? A review of the literature and considerations from a single-center experience
Authors
Davide Paoli
Russell Mills
Una Brechany
Nicola Pavese
Claire Nicholson
Publication date
21-01-2023
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 4/2023
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-023-11569-6

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