Background: Orthostatic tremor (OT) is characterized by high-frequency leg tremor when standing still, resulting in a sense of imbalance, with limited treatment options. Ventral intermediate (Vim) nucleus thalamic deep brain stimulation (DBS) has been reported as beneficial in a few cases. Objective: To report clinical outcomes, lead locations, and stimulation parameters in 2 patients with severe medication-refractory OT treated with Vim DBS. Methods: The patients underwent surface electromyography (EMG) to confirm the OT diagnosis. Outcomes were measured as change in tolerated standing time at the last follow-up. Lead locations were quantified using postoperative MRI. Results: Vim DBS was well tolerated and resulted in improvement in standing time (patient 1: 50 s at baseline to 15 min 16 months after surgery; patient 2: 34 s at baseline to 4.2 min 7 months after surgery). Postoperative surface EMG for patient 1 demonstrated a delayed onset of tremor, lower-amplitude tremor, and periods of quiescence, but an unchanged tremor frequency. Conclusion: These cases provide further support for Vim DBS to improve standing time in severe medication-refractory OT. The location of the effective thalamic target for OT does not differ from the effective target for essential tremor.

Keywords:
Orthostatic tremor, Deep brain stimulation, Tremor , Ventral intermediate nucleus, Outcome, Surgical treatment , Thalamic stimulation
1.
Gerschlager W, Münchau A, Katzenschlager R, Brown P, Rothwell JC, Quinn N, Lees AJ, Bhatia KP: Natural history and syndromic associations of orthostatic tremor: a review of 41 patients. Mov Disord 2004;19:788-795.
2.
Yaltho TC, Ondo WG: Orthostatic tremor: a review of 45 cases. Parkinsonism Relat Disord 2014;20:723-725.
3.
Gerschlager W, Katzenschlager R, Schrag A, Lees AJ, Brown P, Quinn N, Bhatia KP: Quality of life in patients with orthostatic tremor. J Neurol 2003;250:212-215.
4.
Krauss JK, Weigel R, Blahak C, Bäzner H, Capelle HH, Grips E, Rittmann M, Wöhrle JC: Chronic spinal cord stimulation in medically intractable orthostatic tremor. J Neurol Neurosurg Psychiatry 2006;77:1013-1016.
5.
Espay AJ, Duker AP, Chen R, Okun MS, Barrett ET, Devoto J, Zeilman P, Gartner M, Burton N, Miranda HA, Mandybur GT, Zesiewicz TA, Foote KD, Revilla FJ: Deep brain stimulation of the ventral intermediate nucleus of the thalamus in medically refractory orthostatic tremor: preliminary observations. Mov Disord 2008;23:2357-2362.
6.
Guridi J, Rodriguez-Oroz MC, Arbizu J, Alegre M, Prieto E, Landecho I, Manrique M, Artieda J, Obeso JA: Successful thalamic deep brain stimulation for orthostatic tremor. Mov Disord 2008;23:1808-1811.
7.
Lyons MK, Behbahani M, Boucher OK, Caviness JN, Evidente VG: Orthostatic tremor responds to bilateral thalamic deep brain stimulation. Tremor Other Hyperkinet Mov (NY) 2012, Epub ahead of print.
8.
Magariños-Ascone C, Ruiz FM, Millan AS, Montes E, Regidor I, del Alamo de Pedro M, Figueiras-Mendez R: Electrophysiological evaluation of thalamic DBS for orthostatic tremor. Mov Disord 2010;25:2476-2477.
9.
Muthuraman M, Hellriegel H, Paschen S, Hofschulte F, Reese R, Volkmann J, Witt K, Deuschl G, Raethjen J: The central oscillatory network of orthostatic tremor. Mov Disord 2013;28:1424-1430.
10.
Yaltho TC, Ondo WG: Thalamic deep brain stimulation for orthostatic tremor. Tremor Other Hyperkinet Mov (NY) 2011, Epub ahead of print.
11.
Contarino MF, Bour LJ, Schuurman PR, Blok ER, Odekerken VJ, van den Munckhof P, de Bie RM, van Rootselaar AF: Thalamic deep brain stimulation for orthostatic tremor: clinical and neurophysiological correlates. Parkinsonism Relat Disord 2015;21:1005-1007.
12.
Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Mosley A, Marks WJ Jr: Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 2002;97:370-387.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.