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Case Reports
. 2024 Jul 4:14:35.
doi: 10.5334/tohm.918. eCollection 2024.

An Eye on the First Surgical Side: Appreciating the Potential Impacts of a Second DBS Lead on Ipsilateral Symptoms

Ariane Veilleux Carpentier  1   2 , Jason L Chan  1   2 , Joshua K Wong  1   2 , Michael S Okun  1   2
Affiliations
Case Reports

An Eye on the First Surgical Side: Appreciating the Potential Impacts of a Second DBS Lead on Ipsilateral Symptoms

Ariane Veilleux Carpentier et al. Tremor Other Hyperkinet Mov (N Y). .

Abstract

Clinical vignette: A 63-year-old man with severe essential tremor underwent staged bilateral ventralis intermedius (Vim) deep brain stimulation (DBS). Left Vim DBS resulted in improved right upper extremity tremor control. Months later, the addition of right Vim DBS to the other brain hemisphere was associated with acute worsening of the right upper extremity tremor.

Clinical dilemma: In staged bilateral Vim DBS, second lead implantation may possibly alter ipsilateral tremor control. While ipsilateral improvement is common, rarely, it can disrupt previously achieved benefit.

Clinical solution: DBS programming, including an increase in left Vim DBS amplitude, re-established and enhanced bilateral tremor control.

Gap in knowledge: The mechanisms underlying changes in ipsilateral tremor control following a second lead implantation are unknown. In this case, worsening and subsequent improvement after optimization highlight the potential impact of DBS implantation on the ipsilateral side.

Expert commentary: After staged bilateral Vim DBS, clinicians should keep an eye on the first or original DBS side and carefully monitor for emergent side effects or worsening in tremor. Ipsilateral effects resulting from DBS implantation present a reprogramming opportunity with a potential to further optimize clinical outcomes.

Highlights: This case report highlights the potential for ipsilateral tremor worsening following staged bilateral DBS and provides valuable insights into troubleshooting and reprogramming strategies. The report emphasizes the importance of vigilant monitoring and individualized management in optimizing clinical outcomes for patients undergoing staged bilateral DBS for essential tremor.

Keywords: deep brain stimulation; essential tremor; ipsilateral; microlesion effect; patient selection; staged surgeries.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Evolution of Archimedes spirals with deep brain stimulation surgeries and optimization
Figure 1
Archimedes spirals evolution. A: Prior to staged bilateral Vim DBS, the patient was unable to draw Archimedes spirals with either hand due to severe tremor. B: After initial optimization of the left Vim DBS, his right-hand tremor improved. C: After right Vim lead implantation, there was unexpected ipsilateral worsening of right-hand tremor, and he was unable to engage a pen to paper or draw a spiral (similar to the pre-operative state). D: The left-hand tremor improved following right Vim DBS optimization. E: Following optimization of bilateral DBS, with an increase in left Vim amplitude, there was further improvement of tremor documented in both hands. Created with BioRender.com.
Decussating and non-decussating pathways of the dentatorubrothalamic tract
Figure 2
Dentatorubrothalamic tract (DRTT, solid lines) with non-decussating fibers (nd-DRTT, dashed lines). SCP; superior cerebellar peduncle. Vim; ventralis intermedius nucleus. Created with BioRender.com.
See this image and copyright information in PMC

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References

    1. Mitchell KT, Larson P, Starr PA, Okun MS, Wharen RE, Uitti RJ, et al. Benefits and risks of unilateral and bilateral ventral intermediate nucleus deep brain stimulation for axial essential tremor symptoms. Parkinsonism Relat Disord. 2019. Mar 1; 60: 126–32. DOI: 10.1016/j.parkreldis.2018.09.004 - DOI - PubMed
    1. Prakash P, Deuschl G, Ozinga S, Mitchell KT, Cheeran B, Larson PS, et al. Benefits and Risks of a Staged-Bilateral VIM Versus Unilateral VIM DBS for Essential Tremor. Mov Disord Clin Pract. 2022. Aug 1; 9(6): 775–84. DOI: 10.1002/mdc3.13490 - DOI - PMC - PubMed
    1. Ondo W, Almaguer M, Jankovic J, Simpson RK. Thalamic Deep Brain Stimulation: Comparison Between Unilateral and Bilateral Placement. Arch Neurol. 2001. Feb 1; 58(2): 218–22. DOI: 10.1001/archneur.58.2.218 - DOI - PubMed
    1. Chandra V, Hilliard JD, Foote KD. Deep brain stimulation for the treatment of tremor. J Neurol Sci. 2022. Apr 15; 435: 120190. DOI: 10.1016/j.jns.2022.120190 - DOI - PubMed
    1. Kim MJ, Chang KW, Park SH, Chang WS, Jung HH, Chang JW. Stimulation-Induced Side Effects of Deep Brain Stimulation in the Ventralis Intermedius and Posterior Subthalamic Area for Essential Tremor. Front Neurol. 2021. Jun; 12. DOI: 10.3389/fneur.2021.678592 - DOI - PMC - PubMed

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