A Stimulating Idea: Treating Mixed ET/PD Tremor with Novel DBS Approach (I10-1H)

OBJECTIVE: Through a case series, we aim to demonstrate an effective and novel approach to treating combination Essential Tremor (ET) and Parkinson’s Disease (PD) tremor with one Deep Brain Stimulation lead bilaterally stimulating both the Ventral-Intermediate Nucleus of the thalamus (VIM) for ET and the Subthalamic Nucleus (STN) for PD. BACKGROUND: Deep Brain Stimulation (DBS) is an established treatment for many of the symptoms associated with ET and PD. With proper lead placement and device programming, significant improvement can be gained in the tremor of ET and the motor symptoms of PD. The majority of DBS implantations for ET or PD have targeted separately the VIM of the thalamus for ET or the STN for PD. Co-diagnosis of PD exists in approximately 20[percnt] of patients with ET, making pertinent an approach to improve both conditions with one surgery. Prior studies have shown symptomatic control in DBS cases targeting the VIM and STN with two separate leads, while other studies have shown control with DBS targeting of the thalamus combined with STN lesioning. Currently, no case reports are available that utilize one DBS lead implanted bilaterally spanning both targets. DESIGN/METHODS: We present four cases of patients with mixed tremor (diagnosed ET+PD), where one DBS lead was inserted bilaterally allowing stimulation of both the VIM nucleus of the thalamus and the STN below with hopes of allowing for improved control of both distinct syndromes. RESULTS: Bilateral insertion of DBS leads spanning both the VIM nucleus of the thalamus and the STN improved the clinical symptoms of these four patients’ ET and PD. CONCLUSIONS: Our case series suggests it is very effective to implant one DBS lead bilaterally to simultaneously stimulate the VIM and the STN to treat both ET and PD symptoms, thus minimizing the number of leads and other procedures.