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Case Reports
. 2023 Sep 1:13:31.
doi: 10.5334/tohm.781. eCollection 2023.

Progressive Multifocal Encephalopathy Holmes Tremor Successfully Treated with Bilateral Deep Brain Stimulation

Talita D Rosa #  1 , Laura Dixon #  1 , Muhammad Ismail Khalid Yousaf  1 , Victoria Holiday  2 , Ajmal Zemmar  2 , Joseph Neimat  2 , Peter Hedera  1
Affiliations
Case Reports

Progressive Multifocal Encephalopathy Holmes Tremor Successfully Treated with Bilateral Deep Brain Stimulation

Talita D Rosa et al. Tremor Other Hyperkinet Mov (N Y). .

Abstract

Background: We report a patient with bilateral HT treated with DBS.

Case report: A 58-year-old man diagnosed with HIV/AIDS and progressive multifocal leukoencephalopathy (PML) presented with 20 years of bilateral arm tremor refractory to therapy. DBS was implanted on the left ventral intermediate nucleus and posterior subthalamic area (VIM/PSA). One year later, a right VIM/PSA DBS was implanted. At twelve months, there were no significant side-effects. With his DBS turned off and on, the Fahn-Tolosa-Marin scale was rated 82 and 58, respectively.

Discussion: To our knowledge, this is the first report of bilateral DBS VIM/PSA treating HT with no significant side effects.

Highlights: We report a successful treatment using deep brain stimulation of bilateral Holmes tremor that was caused by progressive multifocal encephalopathy. The patient achieved 30% improvement in tremor control with a meaningful improvement in his activities of daily living.

Keywords: Deep brain Stimulation; Homes tremor; Rubral Tremor; Tremor.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

MRI brain. Preoperative MRI revealing late sequela of demyelination with brain atrophy and pathy areas of secondary axonal loss throughout the brain and concavity of the apex of the midbrain
Figure 1
MRI brain. Preoperative MRI revealing late sequela of demyelination with brain atrophy and pathy areas of secondary axonal loss throughout the brain and concavity of the apex of the midbrain.
Fahn-Tolosa-Marin rating scale of tremor Drawings A, B and C. Drawings with stimulation on, using left hand (left) and right hand (right). Drawings with the stimulation off are not shown because the patient was not able to perform either task
Figure 2
Fahn-Tolosa-Marin rating scale of tremor Drawings A, B and C. Drawings with stimulation on, using left hand (left) and right hand (right). Drawings with the stimulation off are not shown because the patient was not able to perform either task.
See this image and copyright information in PMC

References

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