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


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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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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Correspondence to Manjul Tripathi.

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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.

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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).

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  • Rubral tremor
  • Thalamotomy
  • Midbrain tremor
  • Dystonia