One-trajectory subthalamic nucleus and ventral intermediate nucleus asleep deep brain stimulation surgery for tremor-dominant Parkinson’s disease: A case report and literature review

Abstract

Background: Deep brain stimulation (DBS) is a well-established treatment for the tremor symptoms of Parkinson’s disease (PD) or essential tremor. Various structures can be considered targets to be stimulated in tremor treatment.Case description: We described a case of a patient with tremor-dominant Parkinson's disease (td-PD) and a family history of essential tremor, who underwent one-trajectory subthalamic nucleus (STN) and ventral intermediate nucleus (Vim) DBS surgery via a parietal approach under general anesthesia. Microelectrode recordings were performed to localize the STN and Vim. Two years postoperatively, there was an improvement of 61.64% in total motor symptoms and of 80.77% in tremor symptoms in the off-medication and on-stimulation states compared with that in the preoperative off-medication state. The levodopa equivalent daily dosage was reduced from 450 mg to 300 mg. Conclusion: For patients with td-PD with refractory tremors, one-trajectory STN and Vim DBS surgery could improve symptoms and might provide a wider programming window for postoperative management.

Keywords

• Tremor dominant Parkinson’s disease
• Essential tremor
• Deep brain stimulation
• Subthalamic nucleus
• Ventral intermediate nucleus