Journal
CLINICAL NEUROLOGY AND NEUROSURGERY
Volume 111, Issue 4, Pages 376-379Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.clineuro.2008.10.017
Keywords
Tremor; Intra-operative monitoring; CATSYS; Essential Tremor
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Funding
- National Parkinson Foundation Inc. (Miami, FL)
- National Institutes of Health (NIH)
- National Parkinson Foundation
- Muscular Dystrophy Association
- Alzheimer Association
- Stanley Glaser Foundation
- University of Miami
- Institute of Ethnomedicine
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Essential Tremor (ET) is characterized by a 4-12-Hz postural and kinetic tremor, most commonly affecting the upper limbs. Deep brain stimulation (DBS) of the thalamus (Vim) has been found to be highly effective in severe/refractory forms of ET. Intra-operative assessment of tremor is performed using clinical methods based on patient and physician perception of tremor intensity. We present for the first time the case of a patient whose tremor was objectively monitored/quantified pre- and intra-operatively using device-based tremor registration to supplement clinical measures. We present the case of a 76-year-old right-handed woman that received unilateral (left-sided) DBS of the ventrointermediate (Vim) nucleus of thalamus (Vim) for medically refractory ET. Tremor was monitored with an accelerometer-based Tremor Pen (R), which is part of a simple portable device (CATSYS 2000 System (R), Danish Product Development Ltd., DK, www.catsys.dk). The patient was asked to perform tasks for tremor evaluation before and during thalamic DBS. Tremor quantification revealed a significant improvement (34.7-fold) in the contralateral (right) limb following macro-stimulation. No significant improvement was registered in the ipsilateral (non-operated) side. Simple electronic tremor registration methods during DBS of the Vim nucleus of the thalamus may supplement the existing methodology that is solely based on subjective measures derived from clinical observations. (C) 2008 Elsevier B.V. All rights reserved.
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