Reduction of thalamic tremor with deep brain stimulation performed for post stroke chronić central pain
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Institute of Rural Health, Lublin, Poland
Chair and Department of Neurosurgery, Medical University, Lublin, Poland
Ann Agric Environ Med. 2013;20(Special Issue 1):45–47
Deep brain stimulation (DBS) of the sensory thalamus and the periventricular/ peri-aqueductal grey area complex may be applied for the treatment of intractable neuropathic pain syndrome. The presented study concerns a patient who experienced ischemic stroke within the posterolateral part of the left hypothalamus, with subsequent severe burning pain localized in the right upper limb, predominantly within the hand, and thalamic tremor which occurred 4 months after the stroke. After 2 years of ineffective pain treatment, the patient was offered implantation of electrodes to the periventricular grey matter (PVG)/periaqueductal grey matter (PAG), as well as implantation of an electrode to the ventroposterolateral thalamic nucleus (VPL). Soon after starting simultaneous PAG/PVG and PVL stimulation, significant alleviation of the patient’s halamic tremor in the hand was observed, which persisted over subsequent months. The presented study discusses possible mechanism underlying tremor suppression in the patient concerned, probably at the level of the cerebellar outflow pathways. The study highlights the fact that DBS provide more insight into the functional anatomy of the thalamus, which used to be available only from animal studies.
Mazars G, Marienne L, Cioloca C. Control of dyskinesias due to sensory deafferentation by means of thalamic stimulation. Acta Neurochir Suppl. 1980; 30: 239–242.
Owen SL, Green AL, Nandi DD, Bittar RG, Wang S, Aziz TZ. Deep brain stimulation for neuropathic pain. Acta Neurochir Suppl. 2007; 97(2): 111–116.
Steinke W, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Wolf PA et al. Thalamic stroke. Presentation and prognosis of infarcts and hemorrhages. Arch Neurol. 1992; 49(7): 703–710.
Miwa H, Hatori K, Kondo T, Imai H, Mizuno Y. Thalarnic tremor: Case reports and implications of the tremor-generating mechanism. Neurology 1996; 46 (1): 75–79.
Molnar GF, Sailer A, Gunraj CA, Cunic DI, Lang AE, Lozano AM et al. Changes in cortical excitability with thalamic deep brain stimulation. Neurology 2005; 64(11): 1913–1919.
Katayama Y, Tsubokawa T, Hirayama T, Kido G, Tsukiyama T, Iio M. Response of regional cerebral blood flow and oxygen metabolism to thalamic stimulation in humans as revealed by positron emission tomography. J Cereb Blood Flow Metab. 1986; 6(3): 637–641.
Kiss ZH, Mooney DM, Renaud L, Hu B. Neuronal response to local electrical stimulation in rat thalamus: physiological implications for mechanisms of deep brain stimulation. Neuroscience 2002; 113(1): 137–143.
Klein JC, Barbe MT, Seifried C, Baudrexel S, Runge M, Maarouf M, Gasser T, Hattingen E, Liebig T, Deichmann R, Timmermann L, Weise L, Hilker R. The tremor network targeted by successful VIM deep brain stimulation in humans. Neurology 2012; 13: 787–795.
Na J, Kakei S, Shinoda Y. Cerebellar input to corticothalamic neurons in layers V and VI in the motor cortex. Neurosci Res. 1997; 28(1): 77–91.