Marina Picillo1, Vijayashankar Paramanandam2, Francesca Morgante3, Musleh Algarni2, Diana A Olszewska4, Renato Puppi Munhoz2, Tipu Aziz5, Erlick Pereira3, Mojgan Hodaie6, Suneil K Kalia7, Andres M Lozano7, Tim Lynch4, Alfonso Fasano8. 1. Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, Neuroscience Section, University of Salerno, Salerno, Italy. 2. Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada. 3. Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK. 4. Centre for Brain Health, Dublin Neurological Institute, National Centre for Deep Brain Stimulation, Mater Misericordiae University Hospital, Dublin, Ireland. 5. Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK. 6. Toronto Western Hospital, UHN, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 7. Toronto Western Hospital, UHN, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada. 8. Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada. Electronic address: alfonso.fasano@gmail.com.
Abstract
BACKGROUND: Thalamotomy and deep brain stimulation of the ventralis intermedius nucleus are effective symptomatic treatments for tremor, irrespective of the underlying diagnosis. METHODS AND RESULTS: Herein we describe six tremor patients (2 Parkinson's disease, 1 dystonic tremor, 2 Essential tremor plus dystonia, 1 Essential tremor plus ataxia) who underwent thalamic neurosurgery and acutely or sub-acutely developed dystonia that was permanent in three cases and could not be managed with any adjustments in the stimulation settings. Tremor response was excellent. We argue that thalamic procedures disrupted either or both the cerebello-thalamic and the cortico-striato-pallido-thalamo-cortical loop resulting in an increase of the thalamo-cortical outflow and subsequent change in the clinical picture from tremor to dystonia. CONCLUSION: Thalamic neurosurgery might be rarely complicated by dystonia. Why some patients are more prone to develop this adverse event is still unknown and possibly related to intrinsic factors, which certainly need further studies.
BACKGROUND: Thalamotomy and deep brain stimulation of the ventralis intermedius nucleus are effective symptomatic treatments for tremor, irrespective of the underlying diagnosis. METHODS AND RESULTS: Herein we describe six tremorpatients (2 Parkinson's disease, 1 dystonic tremor, 2 Essential tremor plus dystonia, 1 Essential tremor plus ataxia) who underwent thalamic neurosurgery and acutely or sub-acutely developed dystonia that was permanent in three cases and could not be managed with any adjustments in the stimulation settings. Tremor response was excellent. We argue that thalamic procedures disrupted either or both the cerebello-thalamic and the cortico-striato-pallido-thalamo-cortical loop resulting in an increase of the thalamo-cortical outflow and subsequent change in the clinical picture from tremor to dystonia. CONCLUSION: Thalamic neurosurgery might be rarely complicated by dystonia. Why some patients are more prone to develop this adverse event is still unknown and possibly related to intrinsic factors, which certainly need further studies.
Authors: Gabriela S Gilmour; Davide Martino; Karen Hunka; Pia Lawrence; Zelma H T Kiss; Veronica Bruno Journal: Front Neurol Date: 2021-11-29 Impact factor: 4.003
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