Introduction: The clinical efficacy of deep brain stimulation (DBS) for midline tremor has been heterogenous. Here, we present an atypical case with facial and palatal tremor treated with DBS. We aimed to show the difference between the fibers affected by stimulation of the two targets (globus pallidus interna (GPi) and ventral intermediate (Vim) thalamic nucleus) using a normative connectome analysis. Case Report: A 76-year-old woman with a four-year history of severe facial and palatal tremor due to craniofacial dystonia. Following a failed bilateral Vim DBS, explantation of preexisting leads and implantation of bilateral GPi leads resulted in the resolution of tremor symptoms following a failed bilateral Vim DBS. We performed a normalized connectome analysis using the volume of tissue activated (VTA) as a region of interest. The results revealed that the fiber tracts associated with VTA of GPi DBS had connections with the facial area of the motor cortex while the Vim DBS did not. Conclusion: This case study suggests the possibility that GPi DBS may be considered for midline tremor, and that the normative connectome analysis may possibly offer clues as to the structures underpinning a positive response. We may refine targets for some of the more difficult to control symptoms such as the midline tremor in this case.

中文翻译：

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GPi DBS 治疗非帕金森病中线震颤：与失败的丘脑 DBS 的规范性连接组比较


简介：深部脑刺激（DBS）治疗中线震颤的临床疗效存在差异。在这里，我们介绍一个用 DBS 治疗的面部和腭震颤的非典型病例。我们的目的是使用规范的连接组分析来显示受两个目标（苍白球内部（GPi）和腹侧中间（Vim）丘脑核）刺激影响的纤维之间的差异。病例报告：一名76岁女性，因颅面肌张力障碍而出现严重面部和腭震颤病史四年。双侧 Vim DBS 失败后，移出先前存在的导线并植入双侧 GPi 导线，导致双侧 Vim DBS 失败后的震颤症状得到缓解。我们使用激活组织体积 (VTA) 作为感兴趣区域进行标准化连接组分析。结果显示，GPi DBS 的 VTA 相关纤维束与运动皮层的面部区域有联系，而 Vim DBS 则没有。结论：本案例研究表明，GPi DBS 可能被考虑用于治疗中线震颤，并且规范连接组分析可能提供有关支撑积极反应的结构的线索。我们可能会针对一些更难以控制的症状（例如本例中的中线震颤）细化目标。