{"id":"428f113c-3928-4500-98d8-526132fd88d9","slug":"deep-brain-stimulation-of-the-posterior-subthalamic-area-as-an-alternative-strategy-for-management-of-holmes-tremor-a-case-report-and-review-of-the-literature","title":"Deep brain stimulation of the posterior subthalamic area as an alternative strategy for management of Holmes tremor: A case report and review of the literature","authors":["Omid Yousefi","Mojtaba Dayyani","Razieh Rezaei","Hooman Kamran","Ali Razmkon"],"abstract":"Background: Holmes tremor is often refractory to medical treatment and deep brain stimulation of the ventralis intermedius nucleus of the thalamus (VIM-DBS) is the intervention of choice in controlling the tremor. Herein, we present a beneficial alternative strategy for the management of such situations, considering the posterior subthalamic area (PSA) as the target of stimulation. Case Description: We report a 57-year-old male with the right-sided tremor following a traumatic brain injury 20 years ago. He had been diagnosed with Holmes tremor that was not responsive to nonsurgical therapeutic options. When refractoriness confirmed, he became a candidate for VIM-DBS. During the operation, by performing macrostimulation with a maximum of 2 mA of amplitude, the tremor had no response to the stimulation of different tracts, and severe right hemi-body paresthesia occurred; therefore, we modified our approach and targeted the PSA, which resulted in satisfactory control of the tremor. The permanent lead was implanted into the left side PSA. At 1-year follow-up, the right side tremor was under complete control. Conclusion: Our case and other similar pieces of evidence are consistently indicating the potential regulatory effects of PSA-DBS in controlling the Holmes tremor as a feasible alternative strategy when VIM-DBS does not provide a satisfactory response. However, further studies with larger sample size are required to evaluate the long-term response and its possible long-term stimulation-related effects.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/428f113c-3928-4500-98d8-526132fd88d9/featured/hero-1781560801428.png","publishDate":"2022-10-28T00:00:00.000Z","doi":"10.25259/SNI_435_2022","categories":["Stereotactic","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/11/11966/SNI-13-489.pdf"}