Failed DBS for palliation of visual problems in a case of oculopalatal tremor

David Wang, Justin C. Sanchez, Kelly D. Foote, Atchar Sudhyadhom, M. Tariq Bhatti, Steven Lewis, Michael S. Okun

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: To report the results of attempted bilateral red nucleus (RN) deep brain stimulation (DBS) for the palliative treatment of visual problems associated with oculopalatal tremor (OPT). Background: It is hypothesized that OPT results from a defect in the GuillaineMollaret triangle, a circuit that includes connections with the dentate nucleus, the contralateral red nucleus, and the inferior olive. We present a high functioning patient (an accountant) who underwent a palliative trial of RN region DBS in an approach targeted through the subthalamic nucleus region. The aim was to reduce eye tremor and improve vision through interruption of the pathologically oscillating circuit in the GuillaineMollaret triangle. Methods: Following informed consent, a patient with OPT (and failure of multiple classes of medication and botulinum toxin therapy) underwent placement of bilateral DBS electrodes within the region of the RN. He underwent preoperative testing and testing after 12 months of continuous stimulation with the device in monopolar, bipolar, low frequency, and high frequency settings. Results: The patient did not demonstrate significant changes in the neurological examination following the procedure and postoperative programming sessions. Eye tremor was monitored pre- and postoperatively by ocular EMG and did not change in frequency. Following the one-year trial, stimulation was discontinued as there were no improvements in vision. Conclusion: DBS for OPT was not clinically effective. There were many potential reasons for failed efficacy including a failure to implant the electrodes deep and medial enough into the target region because of stimulation induced side effects. Other targets within the GuillaineMollaret circuit (and outside of the circuit) may be more useful, though they may prove to be less safe and even more difficult to access. Better custom designed DBS leads may be needed for such small targets in critical brain regions.

Original languageEnglish
Pages (from-to)71-73
Number of pages3
JournalParkinsonism and Related Disorders
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Fingerprint

Deep Brain Stimulation
Tremor
Red Nucleus
Electrodes
Cerebellar Nuclei
Subthalamic Nucleus
Botulinum Toxins
Postoperative Care
Neurologic Examination
Informed Consent
Palliative Care
Equipment and Supplies
Brain

Keywords

  • DBS
  • Microelectrode recordings
  • Oculopalatal
  • Physiology
  • Red nucleus

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology

Cite this

Wang, D., Sanchez, J. C., Foote, K. D., Sudhyadhom, A., Tariq Bhatti, M., Lewis, S., & Okun, M. S. (2009). Failed DBS for palliation of visual problems in a case of oculopalatal tremor. Parkinsonism and Related Disorders, 15(1), 71-73. https://doi.org/10.1016/j.parkreldis.2008.01.020

Failed DBS for palliation of visual problems in a case of oculopalatal tremor. / Wang, David; Sanchez, Justin C.; Foote, Kelly D.; Sudhyadhom, Atchar; Tariq Bhatti, M.; Lewis, Steven; Okun, Michael S.

In: Parkinsonism and Related Disorders, Vol. 15, No. 1, 01.01.2009, p. 71-73.

Research output: Contribution to journalArticle

Wang, D, Sanchez, JC, Foote, KD, Sudhyadhom, A, Tariq Bhatti, M, Lewis, S & Okun, MS 2009, 'Failed DBS for palliation of visual problems in a case of oculopalatal tremor', Parkinsonism and Related Disorders, vol. 15, no. 1, pp. 71-73. https://doi.org/10.1016/j.parkreldis.2008.01.020
Wang, David ; Sanchez, Justin C. ; Foote, Kelly D. ; Sudhyadhom, Atchar ; Tariq Bhatti, M. ; Lewis, Steven ; Okun, Michael S. / Failed DBS for palliation of visual problems in a case of oculopalatal tremor. In: Parkinsonism and Related Disorders. 2009 ; Vol. 15, No. 1. pp. 71-73.
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