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Case Reports
. 2021 Jul;163(7):1867-1871.
doi: 10.1007/s00701-020-04489-1. Epub 2020 Jul 17.

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

Manjul Tripathi  1   2 , Sahil Mehta  3 , Raghav Singla  4 , Chirag K Ahuja  5 , Naresh Tandalya  3 , Constantin Tuleasca  6   7   8   9 , Aman Batish  4 , Sandeep Mohindra  4 , Abhinav Agrahari  4 , Rupinder Kaur  4
Affiliations
Case Reports

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

Manjul Tripathi et al. Acta Neurochir (Wien). 2021 Jul.

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. CLINICAL TRIAL REGISTRATION NUMBER: Not required.

Keywords: Dystonia; Midbrain tremor; Rubral tremor; Thalamotomy.

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