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Review
. 2016 Aug;16(8):983-97.
doi: 10.1080/14737175.2016.1194756. Epub 2016 Jun 9.

Deep brain stimulation for the treatment of uncommon tremor syndromes

Adolfo Ramirez-Zamora  1 , Michael S Okun  2
Affiliations
Review

Deep brain stimulation for the treatment of uncommon tremor syndromes

Adolfo Ramirez-Zamora et al. Expert Rev Neurother. 2016 Aug.

Abstract

Introduction: Deep brain stimulation (DBS) has become a standard therapy for the treatment of select cases of medication refractory essential tremor and Parkinson's disease however the effectiveness and long-term outcomes of DBS in other uncommon and complex tremor syndromes has not been well established. Traditionally, the ventralis intermedius nucleus (VIM) of the thalamus has been considered the main target for medically intractable tremors; however alternative brain regions and improvements in stereotactic techniques and hardware may soon change the horizon for treatment of complex tremors.

Areas covered: In this article, we conducted a PubMed search using different combinations between the terms 'Uncommon tremors', 'Dystonic tremor', 'Holmes tremor' 'Midbrain tremor', 'Rubral tremor', 'Cerebellar tremor', 'outflow tremor', 'Multiple Sclerosis tremor', 'Post-traumatic tremor', 'Neuropathic tremor', and 'Deep Brain Stimulation/DBS'. Additionally, we examined and summarized the current state of evolving interventions for treatment of complex tremor syndromes. Expert commentary: Recently reported interventions for rare tremors include stimulation of the posterior subthalamic area, globus pallidus internus, ventralis oralis anterior/posterior thalamic subnuclei, and the use of dual lead stimulation in one or more of these targets. Treatment should be individualized and dictated by tremor phenomenology and associated clinical features.

Keywords: Deep brain stimulation; Holmes tremor; cerebellar tremor; complex tremor syndromes; dystonic tremor; multiple sclerosis tremor; post-traumatic tremor.

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Figures

Figure 1.
Figure 1.
LEFT. T1 Weighted Axial Magnetic Resonance image showing multi-target DBS with bilateral thalamic (VIM and VoP) leads along with ipsilateral Gpi DBS (red dot). RIGHT. Upper midbrain anatomical axial image showing the relevant Posterior Subthalamic area DBS anatomy and neurosurgical target (Red X). Red Nucleus (Ru), Subthalamic nucleus (STN), Caudal zona Incerta (cZi), medial lemniscus (Lm). Full color available online
See this image and copyright information in PMC

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