Abstract
Background
Medical treatment is usually ineffective for Holmes’ tremor, and surgery is the treatment of choice for many patients. Here we report the case of a 14-year-old girl who developed Holmes’ tremor related to a thalamic abscess and was successfully treated with thalamic deep brain stimulation.
Case report
The patient presented with left hemiparesis and headache and was hospitalized. Investigation revealed a thalamic abscess in the left cerebral hemisphere. The abscess was drained via stereotactic surgery and a course of antibiotic treatment was completed. Four months after treatment, the patient developed Holmes’ tremor in her left upper extremity. When attempts at medical treatment with levodopa, clonazepam, and trihexyphenidyl all failed, an implant was placed and deep brain stimulation of the ventral intermediate nucleus of the thalamus was initiated. During 2.5 years of follow-up, her tremor diminished by 90%.
Conclusion
This case demonstrates that medically resistant Holmes’ tremor related to a thalamic lesion can be successfully treated with thalamic deep brain stimulation.
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References
Akkus DE, Diramali AB (2006) Postichemic delayed Holmes’ tremor responding to low-dose cabergoline. Mov Disord 21:733–734
Deusch G, Bain P, Brin M (1998) Consensus statement of the Movement Disorder Society on tremor. Ad hoc scientific committee. Mov Disord 13(Suppl 3):2–23
Filali M, Hutchinson WD, Palter VN, Lozano AM, Dostrovsky JO (2004) Stimulation-induced inhibition of neuronal firing in human subthalaic nucleus. Exp Brain Res 156:274–281
Foote KD, Okun MS (2005) Ventralis intermedius plus ventralis oralis anterior and posterior deep brain stimulation for posttraumatic Holmes tremor: two leads may be better than one. Neurosurgery 56(ONS Suppl 2):ONS-445
Foote KD, Seignourel P, Fernandez HH, Romrell J, Whidden E, Jacobson C, Rodriguez RL, Okun MS (2006) Dual electrode thalamic deep brain stimulation for the treatment of posttraumatic and multiple sclerosis tremor. Neurosurg 58(ONS Suppl 2):ONS-280-ONS-286
Goldman MS, Kelly PJ (1992) Symptomatic and functional outcome of stereotactic ventralis lateralis thalamotomy for intention tremor. J Neurosurg 77:223–229
Goto S, Yamada K (2004) Combination of thalamic Vim stimulation and Gpi pallidotomy synergistically abolishes Holmes’ tremor. J Neurol Neurosurg Psychiatry 75:1200–1207
Hertel F, Züchner M, Decker C, Erken E, Libri S, Schmitt M, Bettag M (2006) Unilateral Holmes tremor, clearly responsive to cerebrospinal fluid release, in a patient with an ischemic midbrain lesion and associated chronic hydrocephalic ventricle enlargement. J Neurosurg 104:448–451
Holmes G (1904) On certain tremors in organic cerebral lesions. Brain 27:327–375
Hubble JP, Busenbark KL, Wilkinson S, Pahwa R, Paulson GW, Lyons K, Koller WC (1997) Effects of thalamic deep brain stimulation based on tremor type and diagnosis. Mov Disord 12:337–341
Kim MC, Son BC, Miyagi Y, Kang JK (2002) Vim thalamotomy for Holmes’ tremor secondary to midbrain tumour. J Neurol Neurosurg Psychiatry 73:453–455
Kitagawa M, Murata J, Kikuchi S, Sawamura Y, Saito H, Sasaki H, Tashiro K (2000) Deep brain stimulation of subthalamic area for severe proximal tremor. Neurology 55:114–116
Krack P, Deuschl G, Kaps M, Warnke P, Schneider S, Traupe H (1994) Delayed onset of “rubral tremor” 23 years after brainstem trauma. Mov Disord 9:240–242
Krauss JK, Mohadjer M, Nobbe F, Mundinger F (1994) The treatment of posttraumatic tremor by stereotactic surgery. J Neurosurg 80:810–819
Kudo M, Goto S, Nishikawa S, Hamasaki T, Soyama N, Ushio Y, Mita S, Hirata Y (2001) Bilateral thalamic stimulation for Holmes tremor caused by unilateral brainstem lesion. Mov Disord 16:170–174
Lim DA, Khandhar SM, Heath S, Ostrem JL, Ringel N, Starr P (2007) Multiple target deep brain stimulation for multiple sclerosis related and poststroke Holmes’ tremor. Stereotact Funct Neurosurg 85:144–149
Liou LM, Shih PY (2006) Successful treatment of rubral tremor by high-dose trihexyphenidyl: a case report. Kaohsiung J Med Sci 22:149–153
Nikkhah G, Prokop T, Hellwig B, Lücking CH, Ostertag CB (2004) Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions. J Neurosurg 100:1079–1083
Pahwa R, Lyons KE, Kempf L, Wilkinson SB, Koller WC (2002) Thalamic stimulation for midbrain tremor after partial hemangioma resection. Mov Disord 17:404–407
Pezzini A, Zavarise P, Palvarini L, Viale P, Oladeji O, Padovani A (2002) Holmes’ tremor following midbrain Toxoplasma abscess: clinical features and treatment of a case. Parkinsonism Relat Disord 8:177–180
Raine GB, Velez M, Pardal MF, Micheli F (2007) Holmes tremor secondary to brainstem hemorrhage responsive to levodopa: report of 2 cases. Clin Neuropharmacol 30:95–100
Romanelli P, Bronte-Stewart H, Courtney T, Heit G (2003) Possible necessity for deep brain stimulation of both the ventralis intermedius and subthalamic nuclei to resolve Holmes tremor. J Neurosurg 99:566–571
Samadani U, Umemura A, Jaggi JL, Colcher A, Zager EL, Baltuch GH (2003) Thalamic deep brain stimulation for disabling tremor after excision of a midbrain cavernous angioma. J Neurosurg 98:888–890
Shepherd GMG, Tauböll E, Bakke SJ, Nyberg-Hansen R (1997) Midbrain tremor and hypertrophic olivary degeneration after pontine hemorrhage. Mov Disord 12:432–437
Weng YH, Kao PF, Tsai CH, Yen TC, L CS (2000) Dopamine deficiency in rubral tremor caused by midbrain hemangioma: case report. Chang Gung Med J 23:485–491
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Peker, S., Isik, U., Akgun, Y. et al. Deep brain stimulation for Holmes’ tremor related to a thalamic abscess. Childs Nerv Syst 24, 1057–1062 (2008). https://doi.org/10.1007/s00381-008-0644-2
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DOI: https://doi.org/10.1007/s00381-008-0644-2