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Deep Brain Stimulation of the Ventrolateral Thalamic Base and Posterior Subthalamic Area in Dystonic Head Tremor

  • Carsten BuhmannEmail author
  • Christian K. E. Moll
  • Simone Zittel
  • Alexander Münchau
  • Andreas K. Engel
  • Wolfgang Hamel
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 117)

Abstract

Dystonic head tremor (DHT) is characterized by head tremor associated with cervical dystonia (CD). Deep brain stimulation (DBS) can be considered when local treatment with botulinum toxin or oral medication has failed. However, there is lack of data regarding the optimal target structure for surgery in DHT.

DBS of the ventrolateral (VL) thalamus is an established treatment option for medically refractory tremor. Tremor suppression is described as being most effective when stimulating at the inferior thalamic base and within the posterior subthalamic area (PSA). Moreover, there is surgical evidence from the pre-DBS era that both lesions and high-frequency stimulation of the PSA improve CD. Based on these observations, we performed DBS in three patients with DHT, placing the proximal contacts of the electrodes into the inferior base of VL thalamic nuclei and the distal contacts into the adjacent PSA. Chronic stimulation improved not only head tremor but also CD. These findings suggest that DBS at the base of VL thalamus and the adjacent PSA should undergo further investigation as a potential target for patients with DHT.

Keywords

Cervical dystonia Dystonic tremor Head tremor Deep brain stimulation 

Notes

Financial Disclosure and Potential Conflict of Interest

The authors have occasionally received travel expenses and honoraria from Medtronic Inc. for speaking at meetings.

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Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Carsten Buhmann
    • 1
    Email author
  • Christian K. E. Moll
    • 2
  • Simone Zittel
    • 1
  • Alexander Münchau
    • 1
  • Andreas K. Engel
    • 2
  • Wolfgang Hamel
    • 1
  1. 1.Department of NeurologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Neurophysiology and Pathophysiology, Center of Experimental MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany

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