Abstract
<strong>Background:</strong> Directional, deep-brain stimulation may prove beneficial for targets (1) thinner along the lead trajectory, and (2) whose borders are not easily visible by neuroimaging. When targeting the ventral intermediate (VIM) nucleus of the thalamus for essential tremor, even baseline ataxia may be exacerbated by medial spread of current and antidromic stimulation of vestibular-cerebellar-thalamic afferents. <strong>Case Report:</strong> The present patient with essential tremor developed refractory head tremor leading to implantation of bilateral St. Jude/Abbott segmented leads into the VIM to afford additional programming options. <strong>Discussion:</strong> Video evidence showed that directional stimulation did not exacerbate ataxia beyond baseline, whereas nondirectional stimulation exacerbated ataxia consistently. We discuss how this programming advantage may help address a common complication from DBS implantation for essential tremor patients.
Highlights
Segmented deep-brain stimulation (DBS) leads offer a volume of tissue activation (VTA) that is constrained compared with that offered by nonsegmented leads.[1]
Ataxia is a common clinical feature in patients with essential tremor plus,[2] as suggested above, it may be exacerbated by spread of electrical current away from the ventral intermediate (VIM), especially with bilateral DBS implantation.[3,4,5]
We present a case of a patient who underwent bilateral VIM DBS implantation with segmented electrodes for severe, medically refractory head tremor, with improvement of head tremor, while segmented stimulation dramatically reduced gait ataxia
Summary
Segmented deep-brain stimulation (DBS) leads offer a volume of tissue activation (VTA) that is constrained compared with that offered by nonsegmented leads.[1] The application of directional stimulation may prove beneficial for DBS targets that are (1) thinner on a parallel plane to the lead trajectory, and (2) whose borders are not visible by standard neuroimaging modalities. One such target is the ventral intermediate (VIM) nucleus of the thalamus for essential tremor. We present a case of a patient who underwent bilateral VIM DBS implantation with segmented electrodes for severe, medically refractory head tremor, with improvement of head tremor, while segmented stimulation dramatically reduced gait ataxia
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