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Front. Surg. | doi: 10.3389/fsurg.2018.00021

Successful treatment of Holmes Tremor with deep brain stimulation of the prelemniscal radiations.

 Vicente Martinez1*, Shu-Ching Hu2,  Thomas Foutz2, 3 and  Andew L. Ko4
  • 1Department of Rehabilitation Medicine, University of Washington, United States
  • 2Department of Neurology, University of Washington, United States
  • 3Pediatric Neurology, Seattle Children's Hospital, United States
  • 4Neurological Surgery, University of Washington, United States

Holmes tremor (HT) is a rare movement disorder that is typically associated with cerebellar, thalamic or brainstem lesions following a delay. Treatment of HT with deep brain stimulation (DBS) has yielded positive results however; it is unclear which deep brain targets provide optimal therapeutic effects. Here we describe a case report in which a 34 year old man with HT treated successfully with DBS. The ventrointermediate nucleus (VIM) of the thalamus was considered as the initial target. Following electrode placement we determined that the ventral-most electrode contacts were located in the prelemniscal radiations (Raprl). When stimulating from the Raprl contacts, the patient demonstrated robust, stable therapeutic improvements using remarkably low voltages. Our case report corroborates prior evidence suggesting the Raprl as a viable therapeutic target for treating HT with DBS.

Keywords: Deep Brain Stimulation, DBS, Holmes Tremor, prelemniscal area, tractography

Received: 12 Sep 2017; Accepted: 27 Feb 2018.

Edited by:

Eberval Figueiredo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil

Reviewed by:

Hiroki Toda, Fukui Red Cross Hospital, Japan
Clement Hamani, University of Toronto, Canada  

Copyright: © 2018 Martinez, Hu, Foutz and Ko. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: PhD. Vicente Martinez, University of Washington, Department of Rehabilitation Medicine, 1959 NE Pacific Street, 359740, Seattle, 98125, WA, United States,