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Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson’s disease

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Abstract

Deep brain stimulation (DBS) in the thalamic ventral intermediate (Vim) or the subthalamic nucleus (STN) reportedly improves medication-refractory Parkinson’s disease (PD) tremor. However, little is known about the potential synergic effects of combined Vim and STN DBS. We describe a 79-year-old man with medication-refractory tremor-dominant PD. Bilateral Vim DBS electrode implantation produced insufficient improvement. Therefore, the patient underwent additional unilateral left-sided STN DBS. Whereas Vim or STN stimulation alone led to partial improvement, persisting tremor resolution occurred after simultaneous stimulation. The combination of both targets may have a synergic effect and is an alternative option in suitable cases.

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Correspondence to Markus F. Oertel.

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The authors present the case of a patient with tremor-dominant Parkinson’s disease (PD) who did not improve sufficiently from bilateral DBS targeted to the Vim subnucleus of the thalamus. MR revealed a possibly misplaced left lead. In consideration of the presence of a partial treatment effect a decision was taken not to relocate this lead but instead supplement it with another electrode lead in the STN. Improvement of stimulation equipment has made it possible to retain a lead with partial effect and supplement it with another lead without having to implant yet another pulse generator. Follow-up examinations demonstrated a synergistic effect of these two leads.

This presentation strengthens the argument to retain a partially effective electrode and supplement it with another lead in some other possibly effective target, rather than relocating a single misplaced lead. Furthermore, this article adds to the body of evidence concerning simultaneous stimulation in several target areas, a strategy that subsequent research efforts in the future may prove to be of value, not only as a salvage effort for insufficient initial results but also in select cases as a first-line treatment possibility.

Goran Lind

Stockholm, Sweden

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Oertel, M.F., Schüpbach, W.M.M., Ghika, JA. et al. Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson’s disease. Acta Neurochir 159, 265–269 (2017). https://doi.org/10.1007/s00701-016-3044-5

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  • DOI: https://doi.org/10.1007/s00701-016-3044-5

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