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Holmes Tremor due to Artery of Percheron Infarct: Clinical Case and Treatment Using Deep Brain Stimulation of the Vim and ZI Targets.

ABSTRACT: Background:Holmes tremor (HT) arises from disruption of the cerebellothalamocortical pathways. A lesion can interrupt the projection at any point, resulting in this tremor. We describe a case of HT due to the rare artery of Percheron infarct and its successful treatment using deep brain stimulation. Case report:A 62-year-old woman with a right medial cerebral peduncle and bilateral thalamic stroke developed HT. Ventral intermediate nucleus (Vim) zona incerta (ZI) deep brain stimulation (DBS) surgery was performed, with improvement in her tremor. Discussion:Our case supports the theory that the more caudal ZI target in combination with Vim is beneficial in treating poorly DBS-responsive tremors such as HT.

SUBMITTER: O'Shea SA

PROVIDER: S-EPMC7070701 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Holmes Tremor due to Artery of Percheron Infarct: Clinical Case and Treatment Using Deep Brain Stimulation of the Vim and ZI Targets.

O'Shea Sarah A SA Elkind Mitchell M Pullman Seth L SL Ford Blair B

Tremor and other hyperkinetic movements (New York, N.Y.) 20200107

<h4>Background</h4>Holmes tremor (HT) arises from disruption of the cerebellothalamocortical pathways. A lesion can interrupt the projection at any point, resulting in this tremor. We describe a case of HT due to the rare artery of Percheron infarct and its successful treatment using deep brain stimulation.<h4>Case report</h4>A 62-year-old woman with a right medial cerebral peduncle and bilateral thalamic stroke developed HT. Ventral intermediate nucleus (Vim) zona incerta (ZI) deep brain stimul ...[more]

PMID: 32195040

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Successful Treatment of Holmes Tremor With Deep Brain Stimulation of the Prelemniscal Radiations.

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Holmes' or functional tremor?

Project description:Holmes tremor is a rare kind of hyperkinetic movement disorder, clinically characterized by irregular, monolateral, high-amplitude jerks, sharing a quite similar frequency with those observed in Parkinson's disease; its generation likely relies on a combined involvement of cerebello-thalamic and nigrostriatal pathways.We report the case of a man with a combined resting-postural-kinetic tremor. Neuroimaging revealed an intracranial dermoid cyst at the right pontocerebellar angle with brainstem dislocation. We performed an extensive electrophysiological assessment from the extensor digitorum communis (EDC) and flexor carpi radialis (FCR) muscles.Both the spontaneous variability of tremor frequency and frequency entrainment argued against an organic aetiology. Polymyography revealed: 1) a paradoxical increase of tremor amplitude with mass loading; 2) jerks' synchronization between antagonistic muscles during voluntary contralateral motor performances; 3) tremor inhibition while asking the patient to make a ballistic movement.We suggest a complete psychogenic genesis or, at least in part, a possible co-existence of a rubral tremor with functional traits.Here, we propose a simple and fast test battery for an early diagnosis of functional tremor. Our results prompt further studies to re-define electrodiagnostic criteria in hyperkinetic movement disorders, possibly updating the floating border between organic and psychogenic disease.

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Project description:The cerebral network associated with Holmes tremor has never been determined directly. A previous study reported a brain network that is functionally connected, in healthy individuals, to different lesions that cause Holmes tremor (lesion connectome). We report a 71-year-old man with severe left-sided tremor caused by a microbleed near the right red nucleus. Using accelerometry-fMRI, we show tremor-related activity in contralateral sensorimotor cortex and cerebellar vermis. This network was distinct from, but functionally coupled to, the Holmes lesion connectome. We propose that Holmes tremor involves three distinct cerebral mechanisms: a structural lesion, an intermediate lesion connectome, and symptom-related activity.

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High-voltage VIM Region Deep Brain Stimulation Mimicking Progressive Supranuclear Palsy.

Project description:Deep brain stimulation (DBS) for essential tremor (ET) can cause unwanted side effects.A patient with ET underwent unilateral dual-lead thalamic DBS. He later developed parkinsonism with atypical features and was diagnosed with progressive supranuclear palsy. During presentation for a second opinion, stimulation-induced side effects were suspected. Inactivation of DBS resolved atypical features and superimposed idiopathic Parkinson disease (PD) was diagnosed.This case illustrates the importance of recognizing the possible influence of stimulation-induced side effects and discusses when to utilize dual-lead DBS for ET and the co-occurrence of ET and PD.

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Mapping holmes tremor circuit using the human brain connectome.

Project description:OBJECTIVE:Holmes tremor is a debilitating movement disorder with limited treatment options. Lesions causing Holmes tremor can occur in multiple different brain locations, leaving the neuroanatomical substrate unclear. Here, we test whether lesion locations that cause Holmes tremor map to a connected brain circuit and whether this circuit might serve as a useful therapeutic target. METHODS:Case reports of Holmes tremor caused by focal brain lesions were identified through a systematic literature search. Connectivity between each lesion location and the rest of the brain was computed using resting state functional connectivity magnetic resonance imaging data from 1,000 healthy volunteers. Commonalities across lesion locations were identified. This Holmes tremor circuit was then compared to neurosurgical treatment targets and clinical efficacy. RESULTS:We identified 36 lesions causing Holmes tremor, which were scattered across multiple different brain regions. However, all lesion locations were connected to a common brain circuit with nodes in the red nucleus, thalamus, globus pallidus, and cerebellum. In cases with effective neurosurgical treatment, the treatment target was connected with the lesion location, indicating that a second hit to the same circuit might be beneficial. Commonly used deep brain stimulation targets such as the ventral intermediate nucleus and subthalamic nucleus fell outside our Holmes tremor circuit, whereas the globus pallidus target was close, consistent with published clinical response rates for these targets. INTERPRETATION:Lesions causing Holmes tremor are part of a single connected brain circuit that may serve as an improved therapeutic target. ANN NEUROL 2019;86:812-820.

| S-EPMC6899700 | biostudies-literature

Changes in Midline Tremor and Gait Following Deep Brain Stimulation for Essential Tremor.

Project description:Background:Essential tremor (ET) is a common movement disorder characterized by kinetic and postural tremor in the upper extremities and frequently in the midline. Persons with ET often also exhibit gait ataxia. Previous studies have observed associations between midline tremor severity and gait ataxia in persons with ET, suggesting a common pathophysiology distinct from that of upper extremity tremor. However, a causal link between midline tremor and gait impairment has not been established. Methods:We investigated tremor and gait in 24 persons with ET before and after implantation of unilateral deep brain stimulation into the ventralis intermedius nucleus of the thalamus. Results:Stimulation significantly improved tremor in the targeted upper extremity and midline. However, gait was unaffected at the cohort level. Furthermore, improvement in midline tremor was not significantly associated with gait improvement. Discussion:These findings revealed that midline tremor and gait impairment may be dissociable in persons with ET.

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