Acta Neurochirurgica

, Volume 153, Issue 12, pp 2361–2363 | Cite as

A case of tremor reduction and almost complete ageusia under bilateral thalamic (VIM) deep brain stimulation in essential tremor—a therapeutic dilemma

  • Bastian Sajonz
  • Burkhard Mädler
  • Stephan Herberhold
  • Sebastian Paus
  • Volker A. Coenen
Case Report
First Online:
Received:
Accepted:

Abstract

Essential tremor (ET) is a neurological disorder that can be treated effectively by means of bilateral thalamic ventral intermediate nucleus (VIM) deep brain stimulation (DBS). We present a rare case of stimulation-dependent reversible ageusia that poses a therapeutic dilemma on the one hand and serves as an instructive example to elucidate the as yet incompletely defined gustatory pathways on the other. A 69-year-old patient with successful reduction of his disabling upper extremity ET experienced an almost complete but during stimulation cessation reversible ageusia under bilateral VIM DBS. An evaluation of diffusion tensor (DTI) neuroimaging studies was performed in order to detect effective electrode positions and volumes of activated tissue (VTA) in relation to the medial lemniscus (ML) and dentato-rubro-thalamic tract (DRT). Repeated subjective gustometry was conducted with differential manipulation of stimulation settings. This case report stresses the importance of fiber tracts for DBS surgery. Reconciled with previous findings in lesion cases, we assume the coexistence of decussating and non-decussating fibers in the gustatory tract combined with hemispheric dominance in the processing of gustatory information. A therapeutic option for this dilemma may be a patient-selectable stimulation program or bipolar stimulation establishing a smaller ovoid VTA.

Keywords

Ageusia Deep brain stimulation Adverse events Essential tremor  Diffusion tensor imaging 
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Notes

Conflicts of interest

None.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Bastian Sajonz
    • 1
  • Burkhard Mädler
    • 1
  • Stephan Herberhold
    • 2
  • Sebastian Paus
    • 3
  • Volker A. Coenen
    • 1
  1. 1.Stereotaxy and MR-based OR techniques/Department of NeurosurgeryUniversity of BonnBonnGermany
  2. 2.Department of OtorhinolaryngologyUniversity of BonnBonnGermany
  3. 3.Department of NeurologyUniversity of BonnBonnGermany

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