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Unilateral deep brain stimulation (DBS) of nucleus ventralis intermedius thalami (Vim) for the treatment of post-traumatic tremor in children: a multicentre experience

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Abstract

Purpose

Deep brain stimulation (DBS) of nucleus ventralis intermedius thalami (Vim) is a validated technique for the treatment of essential tremor (ET) in adults. Conversely, its use for post traumatic tremor (PTT) and in paediatric patients is still debated. We evaluated the efficacy of Vim-DBS for lesional tremor in three paediatric patients with drug-resistant post-traumatic unilateral tremor.

Methods

We retrospectively collected data regarding three patients with unilateral tremor due to severe head injury, with no MRI evidence of basal ganglia lesions. The three patients underwent stereotactic frame-based robot-assisted DBS of Vim contralateral to the tremor side.

Results

Mean follow-up was 48 months (range: 36–60 months). Tremor was reduced in all patients with a better control of voluntary movements and improvement of functional status (mean FIM scale improvement + 7 points). No surgical complications occurred.

Conclusion

Unilateral contralateral DBS of Vim could be efficacious in post-traumatic tremor, even in paediatric patients and should be offered in PTT drug-resistant patients.

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Data availability

Data are available from corresponding author upon reasonable request.

Abbreviations

DBS:

Deep brain stimulation

Vim:

Nucleus ventralis intermedius thalami

ET:

Essential tremor

PTT:

Post traumatic tremor

SMD:

Secondary movement disorder

PD:

Parkinson’s disease

MS:

Multiple sclerosis tremor

VOA:

Ventralis oralis anterior

ZI:

Zona incerta

GPi:

Globus pallidus internus

IPG:

Implantable pulse generator

BFMDRS:

Burke-Fahn-Marsden Dystonia Rating Scale

QUEST:

Quality of Upper Extremity Skills Test

QoL:

Quality of life

FIM:

Functional independence measure

DT:

Dystonic tremor

VOP:

Ventro-oralis posterior

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Funding

This study was funded in part by the Annual Funding for the Current Research by the Italian Ministry of Health.

Author information

Author notes

  1. Simone Peraio, Giorgio Mantovani and Tommaso Araceli have contributed equally to this paper.

Authors and Affiliations

  1. Department of Neurosurgery, Meyer Children’s Hospital IRCCS, Florence, Italy

    Simone Peraio, Tommaso Araceli, Alice Noris, Andrea Di Rita & Flavio Giordano

  2. Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy

    Giorgio Mantovani, Lorenzo Mongardi & Michele Alessandro Cavallo

  3. Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany

    Tommaso Araceli

  4. Pediatric Neurology Clinic - Meyer Children’s Hospital IRCCS, Florence, Italy

    Edoardo Fino, Federico Melani, Matteo Lenge & Renzo Guerrini

  5. Istituto Medea “La Nostra Famiglia” IRCCS, Bosisio Parini, LC, Italy

    Francesca Formica & Luigi Piccinini

  6. Istituto Stella Maris – IRCCS – University of Pisa, Pisa, Italy

    Roberta Scalise & Roberta Battini

  7. Department of Biology, Harding University, Searcy, AR, USA

    Tayler Appleton

  8. Department of Radiology, Meyer Children’s Hospital IRCCS, Florence, Italy

    Ludovico D’Incerti

  9. University of Florence, Florence, Italy

    Edoardo Fino, Renzo Guerrini & Flavio Giordano

Authors
  1. Simone Peraio
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  2. Giorgio Mantovani
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  3. Tommaso Araceli
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  4. Lorenzo Mongardi
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  5. Alice Noris
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  6. Edoardo Fino
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  9. Federico Melani
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  10. Matteo Lenge
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  11. Roberta Scalise
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  13. Andrea Di Rita
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  16. Michele Alessandro Cavallo
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  18. Flavio Giordano
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Contributions

Conceptualization: Peraio, Giordano. Methodology: Peraio, Giordano, Araceli, Scalise. Formal analysis and investigation: Mantovani, Mongardi, Fino, Formica, Piccinini, Battini. Writing - original draft preparation: Mantovani, Araceli, Mongardi. Writing - review and editing: Araceli, Noris, Di Rita, Lenge, Fino, Melani, Scalise, Cavallo, Guerrini. Supervision: Giordano, Cavallo, Guerrini.

Corresponding author

Correspondence to Matteo Lenge.

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Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Local Ethical Committee.

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Patients’ parents gave a fully signed informed consent about the surgical procedure and expected outcome.

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The authors declare no competing interests.

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Peraio, S., Mantovani, G., Araceli, T. et al. Unilateral deep brain stimulation (DBS) of nucleus ventralis intermedius thalami (Vim) for the treatment of post-traumatic tremor in children: a multicentre experience. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06380-1

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