Skip to main content

Deep brain stimulation of the centromedian thalamic nucleus for essential tremor: a case report

Acta Neurochirurgica volume 159, pages 789–793 (2017)Cite this article

Abstract

The centromedian nucleus (CM) of the thalamus is an important site with anatomical connections to different cortical and subcortical motor areas; however, its role in tremor disorders is not clear, although deep brain stimulation (DBS) of the CM has been described to be effective in the treatment of parkinsonian tremor. We report a case of a patient with medication-refractory essential tremor (ET) who had excellent tremor suppression with DBS of the CM. The CM and the nearby region should be explored as a potential target for the treatment of ET and other forms of tremor.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Adams JE, Rutkin BB (1965) Lesions of the centrum medianum in the treatment of movement disorders. Confin Neurol 26:231–245

    CAS  PubMed  Google Scholar 

  2. Blomstedt P, Sandvik U, Linder J, Fredricks A, Forsgren L, Hariz MI (2011) Deep brain stimulation of the subthalamic nucleus versus the zona incerta in the treatment of essential tremor. Acta Neurochir 153:2329–2335

    Article  PubMed  Google Scholar 

  3. Bostan AC, Dum RP, Strick PL (2010) The basal ganglia communicate with the cerebellum. Proc Natl Acad Sci U S A 107:8452–8456

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Caparros-Lefebvre D, Blond S, Feltin MP, Pollak P, Benabid AL (1999) Improvement of levodopa induced dyskinesias by thalamic deep brain stimulation is related to slight variation in electrode placement: possible involvement of the centre median and parafascicularis complex. J Neurol Neurosurg Psychiatry 67:308–314

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. Fahn S, Tolosa E, Concepcion M (1993) Clinical rating scale for tremor. In: Jankovic J, Tolosa E (eds) Parkinson’s disease and movement disorders. Williams and Wilkins, Baltimore, pp 271–280

    Google Scholar 

  6. Garonzik IM, Hua SE, Ohara S, Lenz FA (2002) Intraoperative microelectrode and semi-microelectrode recording during the physiological localization of the thalamic nucleus ventral intermediate. Mov Disord: Off J Mov Disord Soc 17(Suppl 3):S135–S144

    Article  Google Scholar 

  7. Hallett M (2014) Tremor: pathophysiology. Parkinsonism Relat Disord 20(Suppl 1):S118–S122

    Article  PubMed  Google Scholar 

  8. Hoshi E, Tremblay L, Feger J, Carras PL, Strick PL (2005) The cerebellum communicates with the basal ganglia. Nat Neurosci 8:1491–1493

    CAS  Article  PubMed  Google Scholar 

  9. Krauss JK, Pohle T, Weigel R, Burgunder JM (2002) Deep brain stimulation of the centre median-parafascicular complex in patients with movement disorders. J Neurol Neurosurg Psychiatry 72:546–548

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Papavassiliou E, Rau G, Heath S, Abosch A, Barbaro NM, Larson PS, Lamborn K, Starr PA (2008) Thalamic deep brain stimulation for essential tremor: relation of lead location to outcome. Neurosurgery 62(Suppl 2):884–894

    PubMed  Google Scholar 

  11. Pelzer EA, Melzer C, Timmermann L, von Cramon DY, Tittgemeyer M (2017) Basal ganglia and cerebellar interconnectivity within the human thalamus. Brain Struct Funct 222(1):381–392

  12. Peppe A, Gasbarra A, Stefani A, Chiavalon C, Pierantozzi M, Fermi E, Stanzione P, Caltagirone C, Mazzone P (2008) Deep brain stimulation of CM/PF of thalamus could be the new elective target for tremor in advanced Parkinson’s Disease? Parkinsonism Relat Disord 14:501–504

    CAS  Article  PubMed  Google Scholar 

  13. Sadikot AF, Rymar VV (2009) The primate centromedian-parafascicular complex: anatomical organization with a note on neuromodulation. Brain Res Bull 78:122–130

    Article  PubMed  Google Scholar 

  14. Sandvik U, Koskinen LO, Lundquist A, Blomstedt P (2012) Thalamic and subthalamic deep brain stimulation for essential tremor: where is the optimal target? Neurosurgery 70:840–845, discussion 845-846

    Article  PubMed  Google Scholar 

  15. Sitburana O, Almaguer M, Ondo WG (2010) A pilot study: microlesion effects and tremor outcome in the ventrointermediate deep brain stimulation (VIM-DBS). Clin Neurol Neurosurg 112:106–109

    Article  PubMed  Google Scholar 

  16. Smith Y, Raju DV, Pare JF, Sidibe M (2004) The thalamostriatal system: a highly specific network of the basal ganglia circuitry. Trends Neurosci 27:520–527

    CAS  Article  PubMed  Google Scholar 

  17. Stover NP, Okun MS, Evatt ML, Raju DV, Bakay RA, Vitek JL (2005) Stimulation of the subthalamic nucleus in a patient with Parkinson disease and essential tremor. Arch Neurol 62:141–143

    Article  PubMed  Google Scholar 

  18. Wahren W, Schaltenbrand G (1977) Atlas for stereotaxy of the human brain. Thieme

Download references

Author information

Author notes

  1. Vibhash D. Sharma

    Present address: Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA

Affiliations

  1. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA

    Vibhash D. Sharma, Klaus Mewes, Thomas Wichmann, Cathrin Buetefisch & Mahlon DeLong

  2. Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA

    Thomas Wichmann

  3. Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Jon T. Willie

Authors
  1. Vibhash D. Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Mewes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Wichmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cathrin Buetefisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jon T. Willie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mahlon DeLong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vibhash D. Sharma.

Ethics declarations

Patient consent

The patient has consented to submission of this case report to the journal.

Financial disclosures/Conflict of interest

None of the authors has any relevant financial or non-financial relationships to disclose.

Funding sources for study

Thomas Wichmann: The writing of this article was supported by a grant from the NIH/ORIP to the Yerkes Center (P51-OD011132). Mahlon DeLong: received support from APDA for writing this article.

Additional information

Comments

This is an interesting case report describing the complexity of surgical treatments of movement disorders. It is well written and the discussion of possible mechanisms of CM having a role in ET is good.

Ulrike Sandvik

Stockholm, Sweden

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sharma, V.D., Mewes, K., Wichmann, T. et al. Deep brain stimulation of the centromedian thalamic nucleus for essential tremor: a case report. Acta Neurochir 159, 789–793 (2017). https://doi.org/10.1007/s00701-017-3143-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-017-3143-y

Keywords

  • Deep brain stimulation
  • Essential tremor
  • Centromedian nucleus
  • Case report