Skip to main content
SpringerLink
Log in
Book cover

Stereotactic and Functional Neurosurgery pp 67–72Cite as

Deep Brain Stimulation of the Ventrolateral Thalamic Base and Posterior Subthalamic Area in Dystonic Head Tremor

  • Conference paper
  • First Online:

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 117))

Abstract

Dystonic head tremor (DHT) is characterized by head tremor associated with cervical dystonia (CD). Deep brain stimulation (DBS) can be considered when local treatment with botulinum toxin or oral medication has failed. However, there is lack of data regarding the optimal target structure for surgery in DHT.

DBS of the ventrolateral (VL) thalamus is an established treatment option for medically refractory tremor. Tremor suppression is described as being most effective when stimulating at the inferior thalamic base and within the posterior subthalamic area (PSA). Moreover, there is surgical evidence from the pre-DBS era that both lesions and high-frequency stimulation of the PSA improve CD. Based on these observations, we performed DBS in three patients with DHT, placing the proximal contacts of the electrodes into the inferior base of VL thalamic nuclei and the distal contacts into the adjacent PSA. Chronic stimulation improved not only head tremor but also CD. These findings suggest that DBS at the base of VL thalamus and the adjacent PSA should undergo further investigation as a potential target for patients with DHT.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Blomstedt P, Sandvik U, Tisch S (2010) Deep brain stimulation in the posterior subthalamic area in the treatment of essential tremor. Mov Disord 25(10):1350–1356

    Article  PubMed  Google Scholar 

  2. Chou KL, Hurtig HI, Jaggi JL, Baltuch GH (2005) Bilateral subthalamic nucleus deep brain stimulation in a patient with cervical dystonia and essential tremor. Mov Disord 20(3):377–380

    Article  PubMed  Google Scholar 

  3. Deuschl G (2003) Dystonic tremor. Rev Neurol (Paris) 159(10 Pt 1):900–905

    CAS  Google Scholar 

  4. Deuschl 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

    PubMed  Google Scholar 

  5. Deuschl G, Heinen F, Kleedorfer B, Wagner M, Lucking CH, Poewe W (1992) Clinical and polymyographic investigation of spasmodic torticollis. J Neurol 239(1):9–15

    Article  PubMed  CAS  Google Scholar 

  6. Gironell A, Kulisevsky J (2009) Diagnosis and management of essential tremor and dystonic tremor. Ther Adv Neurol Disord 2(4):215–222

    Article  PubMed  Google Scholar 

  7. Hamel W, Fietzek U, Morsnowski A, Schrader B, Herzog J, Weinert D, Pfister G, Muller D, Volkmann J, Deuschl G, Mehdorn HM (2003) Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: evaluation of active electrode contacts. J Neurol Neurosurg Psychiatry 74(8):1036–1046

    Article  PubMed  CAS  Google Scholar 

  8. Hamel W, Herzog J, Kopper F, Pinsker M, Weinert D, Muller D, Krack P, Deuschl G, Mehdorn HM (2007) Deep brain stimulation in the subthalamic area is more effective than nucleus ventralis intermedius stimulation for bilateral intention tremor. Acta Neurochir (Wien) 149(8):749–758

    Article  CAS  Google Scholar 

  9. Hassler R (1954) Experimentelle und anatomische Befunde über die Drehbewegungen und ihre nervösen Apparate. Arch Psychiat Nervenkr 192:488–526

    Article  PubMed  CAS  Google Scholar 

  10. Hassler R (1965) Correlations between clinical and autoptic findings in stereotaxic operations of parkinsonism. Confin Neurol 26:282–290

    PubMed  CAS  Google Scholar 

  11. Hyde JE, Toczek S (1962) Functional relation of interstitial nucleus to rotatory movements evoked from zona incerta stimulation. J Neurophysiol 25:455–466

    PubMed  CAS  Google Scholar 

  12. Jankovic J, Leder S, Warner D, Schwartz K (1991) Cervical dystonia: clinical findings and associated movement disorders. Neurology 41(7):1088–1091

    Article  PubMed  CAS  Google Scholar 

  13. Jedynak CP, Bonnet AM, Agid Y (1991) Tremor and idiopathic dystonia. Mov Disord 6(3):230–236

    Article  PubMed  CAS  Google Scholar 

  14. Jeong SG, Lee MK, Lee WH, Ghang CG (2009) Deep brain stimulation of the subthalamic area for dystonic tremor. J Korean Neurosurg Soc 45(5):303–305

    Article  PubMed  Google Scholar 

  15. Jones EG (1985) The thalamus. Plenum Press, New York

    Book  Google Scholar 

  16. Krause M, Fogel W, Kloss M, Rasche D, Volkmann J, Tronnier V (2004) Pallidal stimulation for dystonia. Neurosurgery 55(6):1361–1368

    Article  PubMed  Google Scholar 

  17. Moll CK, Hamel W, Ostertag CB, Muller D, Finsterbusch J, Engel AK, Munchau A (2008) Subthalamotomy in cervical dystonia: a case study of lesion location and clinical outcome. Mov Disord 23(12):1751–1756

    Article  PubMed  Google Scholar 

  18. Moll CK, Sharott A, Hamel W, Munchau A, Buhmann C, Hidding U, Zittel S, Westphal M, Muller D, Engel AK (2009) Waking up the brain: a case study of stimulation-induced wakeful unawareness during anaesthesia. Prog Brain Res 177:125–145

    Article  PubMed  Google Scholar 

  19. Morishita T, Foote KD, Haq IU, Zeilman P, Jacobson CE, Okun MS (2010) Should we consider Vim thalamic deep brain stimulation for select cases of severe refractory dystonic tremor. Stereotact Funct Neurosurg 88(2):98–104

    Article  PubMed  Google Scholar 

  20. Mundinger F (1977) New stereotactic treatment of spasmodic torticollis with a brain stimulation system (author’s transl). Med Klin 72(46):1982–1986

    PubMed  CAS  Google Scholar 

  21. Mundinger F, Riechert T, Disselhoff J (1972) Long-term results of stereotactic treatment of spasmodic torticollis. Confin Neurol 34(2):41–50

    Google Scholar 

  22. Pal PK, Samii A, Schulzer M, Mak E, Tsui JK (2000) Head tremor in cervical dystonia. Can J Neurol Sci 27(2):137–142

    PubMed  CAS  Google Scholar 

  23. Plaha P, Khan S, Gill SS (2008) Bilateral stimulation of the caudal zona incerta nucleus for tremor control. J Neurol Neurosurg Psychiatry 79(5):504–513

    Article  PubMed  CAS  Google Scholar 

  24. Raethjen J (2011) Current therapy for tremor. Aktuelle Neurol 38(6):315–319

    Article  Google Scholar 

  25. Rivest J, Marsden CD (1990) Trunk and head tremor as isolated manifestations of dystonia. Mov Disord 5(1):60–65

    Article  PubMed  CAS  Google Scholar 

  26. von Monakow C (1895) Experimentelle und pathologisch-anatomische Untersuchungen über die Haubenregion, den Sehhügel und die Regio subthalamica, nebst Beiträgen zur Kenntnis früh erworbener Gross und Kleinhirndefecte. Arch Psychiatr Nervenkr 27:1–128, 386–478

    Article  Google Scholar 

  27. Woehrle JC, Blahak C, Kekelia K, Capelle HH, Baezner H, Grips E, Weigel R, Krauss JK (2009) Chronic deep brain stimulation for segmental dystonia. Stereotact Funct Neurosurg 87(6):379–384

    Article  PubMed  Google Scholar 

  28. Yianni J, Nandi D, Hyam J, Elliott V, Bain P, Gregory R, Aziz T (2004) Failure of chronic pallidal stimulation in dystonic patients is a medical emergency. Neuromodulation 7(1):9–12

    Article  PubMed  Google Scholar 

Download references

Financial Disclosure and Potential Conflict of Interest

The authors have occasionally received travel expenses and honoraria from Medtronic Inc. for speaking at meetings.

Author information

Authors and Affiliations

  1. Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Carsten Buhmann MD, Simone Zittel MD, Alexander Münchau MD & Wolfgang Hamel MD

  2. Department of Neurophysiology and Pathophysiology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Christian K. E. Moll MD & Andreas K. Engel MD, PhD

Authors
  1. Carsten Buhmann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian K. E. Moll MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simone Zittel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Münchau MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas K. Engel MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wolfgang Hamel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carsten Buhmann MD .

Editor information

Editors and Affiliations

  1. , Neurosurgical Clinic, University Hospital Erlangen, Schwabachanlage 6, Erlangen, 91054, Germany

    Guido Nikkhah

  2. Department of Neurosurgery, Division of Stereotactic and Functional, University Medical Center Freiburg, Breisacher Straße 64, Freiburg, 79106, Germany

    Marcus Pinsker

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Wien

About this paper

Cite this paper

Buhmann, C., Moll, C.K.E., Zittel, S., Münchau, A., Engel, A.K., Hamel, W. (2013). Deep Brain Stimulation of the Ventrolateral Thalamic Base and Posterior Subthalamic Area in Dystonic Head Tremor. In: Nikkhah, G., Pinsker, M. (eds) Stereotactic and Functional Neurosurgery. Acta Neurochirurgica Supplement, vol 117. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1482-7_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-1482-7_11

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1481-0

  • Online ISBN: 978-3-7091-1482-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation