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Vim stereotactic radiosurgical thalamotomy for drug-resistant idiopathic Holmes tremor: a case report

Acta Neurochirurgica volume 163, pages 1867–1871 (2021)Cite this article

Abstract

We share our experience with stereotactic gamma knife thalamotomy (GKT) for medically refractory Holmes tremor (HT). A 22-year-old patient underwent gamma knife thalamotomy at ventrointermediate nucleus for disabling HT of the right upper limb. A single 4-mm isocenter was used to target the ventral intermediate nucleus with 130 Gy radiation. At 4 months follow up, we observed 84% improvement in his Fahn-Tolosa-Marin (FTM) rating scale with significant improvement in the right upper limb dystonic tremor. There was only subtle improvement in the ataxic component of the right lower limb. At 1 year after stereotactic GKT, there was sustained neurological improvement with no side effect, We present the stereotactic GKT as a treatment modality for drug-resistant HT. Moreover, it may be considered an alternate treatment modality especially in patients reluctant or contraindicated for any invasive surgical technique.

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References

  1. Artusi CA, Farooqi A, Romagnolo A, Marsili L, Balestrino R, Sokol LL, Wang LL, Zibetti M, Duker AP, Mandybur GT, Lopiano L, Merola A (2018) Deep brain stimulation in uncommon tremor disorders: indications, targets, and programming. J Neurol 265:2473–2493

    Article  Google Scholar 

  2. Aydin S, Canaz H, Erdogan ET, Durmaz N, Topcular B (2017) Holmes’ tremor with shoulder pain treated by deep brain stimulation of unilateral ventral intermediate thalamic nucleus and globus pallidus internus. J Movement Disor 10:92–95

    Article  Google Scholar 

  3. Deuschl G, Bain P, Brin M (1998) Consensus statement of the movement disorder society on tremor. Ad Hoc Sci Committee Mov Disord 13:2–23

    Article  Google Scholar 

  4. Elble R, Bain P, Forjaz MJ, Haubenberger D, Testa C, Goetz CG, Leentjens AFG, Martin PM, Traon AP, Post B, Sampaio C, Stebbins GT, Weintraub D, Schrag A (2013) Task force report: scales for screening and evaluating tremor: critique and recommendations. Mov Disord 28:1793–1800. https://doi.org/10.1002/mds.25648

    Article  PubMed  Google Scholar 

  5. Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, Schwartz M, Hynynen K, Lozano AM, Shah BB, Huss D, Dallapiazza RF, Gwinn R, Witt J, Ro S, Eisenberg HM, Fishman PS, Gandhi D, Halpern CH, Chuang R, Butts Pauly K, Tierney TS, Hayes MT, Cosgrove GR, Yamaguchi T, Abe K, Taira T, Chang JW (2016) A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 375:730–739

    Article  Google Scholar 

  6. Gross RE (2008) What happened to posteroventral pallidotomy for Parkinson’s disease and dystonia? Neurotherapeutics 5:281–293

    CAS  Article  Google Scholar 

  7. Joutsa J, Shih LC, Fox MD (2019) Mapping holmes tremor circuit using the human brain connectome. Ann Neurol 86:812–820

    Article  Google Scholar 

  8. Kim MC, Son BC, Miyagi Y, Kang JK (2002) Vim thalamotomy for Holmes’ tremor secondary to midbrain tumour. J Neurol Neurosurg Psychiatry 73:453–455

    Article  Google Scholar 

  9. Kondziolka D, Ong JG, Lee JY, Moore RY, Flickinger JC, Lunsford LD (2008) Gamma knife thalamotomy for essential tremor. J Neurosurg 108:111–117

    Article  Google Scholar 

  10. Martinez-Moreno NE, Sahgal A, De Salles A, Hayashi M, Levivier M, Ma L, Paddick I, Regis J, Ryu S, Slotman BJ, Martinez-Alvarez R (2018) Stereotactic radiosurgery for tremor: systematic review. J Neurosurg:1–12. https://doi.org/10.3171/2017.8.JNS17749

  11. Mostofi A, Evans JM, Partington-Smith L, Yu K, Chen C, Silverdale MA (2019) Outcomes from deep brain stimulation targeting subthalamic nucleus and caudal zona incerta for Parkinson’s disease. NPJ Parkinson's Dis 5:17

    Article  Google Scholar 

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

    CAS  Article  Google Scholar 

  13. Tripathi M, Sharan S, Mehta S, Deora H, Yagnick NS, Kumar N (2019) Gamma knife radiosurgical pallidotomy for dystonia: not a fallen angel. Neurol India 67:1515–1518

    Article  Google Scholar 

  14. Tuleasca C, Najdenovska E, Regis J, Witjas T, Girard N, Champoudry J, Faouzi M, Thiran JP, Cuadra MB, Levivier M, Van De Ville D (2017) Clinical response to Vim’s thalamic stereotactic radiosurgery for essential tremor is associated with distinctive functional connectivity patterns. Acta Neurochir. https://doi.org/10.1007/s00701-017-3456-x

  15. Tuleasca C, Pralong E, Najdenovska E, Cuadra MB, Marques JRF, Vingerhoets F, Regis J, Bloch J, Levivier M (2017) Deep brain stimulation after previous gamma knife thalamotomy of the Vim for essential tremor is feasible! Clinical, electrophysiological and radiological findings. Acta Neurochir 159:1371–1373

    Article  Google Scholar 

  16. Tuleasca C, Bolton TAW, Regis J, Najdenovska E, Witjas T, Girard N, Delaire F, Vincent M, Faouzi M, Thiran JP, Bach Cuadra M, Levivier M, Van De Ville D (2019) Normalization of aberrant pretherapeutic dynamic functional connectivity of extrastriate visual system in patients who underwent thalamotomy with stereotactic radiosurgery for essential tremor: a resting-state functional MRI study. J Neurosurg:1–10. https://doi.org/10.3171/2019.2.JNS183454

  17. Witjas T, Carron R, Krack P, Eusebio A, Vaugoyeau M, Hariz M, Azulay JP, Regis J (2015) A prospective single-blind study of gamma knife thalamotomy for tremor. Neurology 85:1562–1568

    Article  Google Scholar 

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Acknowledgments

We would like to acknowledge the guidance of the late Professor Kanchan Kumar Mukherjee for his vision and guidance in the management of these cases.

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Authors and Affiliations

  1. Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Manjul Tripathi, Raghav Singla, Aman Batish, Sandeep Mohindra, Abhinav Agrahari & Rupinder Kaur

  2. National Institute of Health Research (NIHR) Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK

    Manjul Tripathi

  3. Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Sahil Mehta & Naresh Tandalya

  4. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Chirag K. Ahuja

  5. Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, France

    Constantin Tuleasca

  6. Faculty of Biology and Medicine (FBM), University of Lausanne (Unil), Lausanne, France

    Constantin Tuleasca

  7. Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, France

    Constantin Tuleasca

  8. Department of Neurosurgery, Lille UniversityHospital, CHU Roger Salengro, Lille, France

    Constantin Tuleasca

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  1. Manjul Tripathi
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  2. Sahil Mehta
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  3. Raghav Singla
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  6. Constantin Tuleasca
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  7. Aman Batish
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  10. Rupinder Kaur
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Corresponding author

Correspondence to Manjul Tripathi.

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The views expressed in this publication are those of the author and not necessarily those of the NIHR or the UK department of Health and Social Care.

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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.

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Informed consent was obtained from all individual participants included in the study. “Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.” The patient has consented for the publication of this report.

Conflict of interest

No conflict of interest/authorship. Constantin Tuleasca gratefully acknowledges receipt of a ‘Young Researcher in Clinical Research Grant’ (JeuneChercheuren Recherche Clinique) from the University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM) and the Lausanne University Hospital (CHUV). Dr. Manjul Tripathi is supported by the National Institute for Health Research (NIHR) Global Health Research Group on Neurotrauma (16/137/105) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK department of Health and Social Care.

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Tripathi, M., Mehta, S., Singla, R. et al. Vim stereotactic radiosurgical thalamotomy for drug-resistant idiopathic Holmes tremor: a case report. Acta Neurochir 163, 1867–1871 (2021). https://doi.org/10.1007/s00701-020-04489-1

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  • DOI: https://doi.org/10.1007/s00701-020-04489-1

Keywords

  • Rubral tremor
  • Thalamotomy
  • Midbrain tremor
  • Dystonia