Neurol. praxi. 2020;21(2):159-161 | DOI: 10.36290/neu.2019.071

Treating Holmes tremor with deep brain stimulation

MUDr. Martin Nevrlý, Ph.D.¹, doc. MUDr. David Krahulík, Ph.D., MBA², MUDr. Pavel Otruba, MBA¹, MUDr. Jan Bardoň¹, prof. MUDr. Petr Kaňovský, CSc., FEAN¹

¹ Neurologická klinika, Fakultní nemocnice a Lékařská fakulta Univerzity Palackého v Olomouci

² Neurochirurgická klinika, Fakultní nemocnice a Lékařská fakulta Univerzity Palackého v Olomouci

Rubral tremor, also known as Holmes tremor (HT), is a relatively rare type of tremor defined as a coarse tremor, accentuated in a static position or during movement. It is usually unilateral, with bilateral involvement occurring only rarely. It occurs due to a lesion of cerebello-rubral pathways. Pharmacological therapy is difficult and, largely, ineffective. Deep brain stimulation (DBS) of the ventral intermediate (VIM) nucleus of the thalamus is a treatment option that, in some cases, can have a very good effect. A case is reported of a 38-year-old woman who, at the age of 37 years old, suffered a left cerebellar hemisphere haemorrhage with subsequent development of gross dyskinesias and ataxia of the left-sided limbs, particularly of the upper limb, diagnosed as HT. The patient was indicated to receive treatment with VIM DBS on the right side; the procedure was uneventful and had a very good effect on the tremor. HT is a relatively rare, highly disabling syndrome caused by a lesion of the cerebello-rubral pathways; however, it could be well managed with VIM DBS.

Keywords: Holmes tremor, deep brain stimulation, ventral intermediate nucleus of the thalamus.

Received: September 21, 2019; Accepted: October 16, 2019; Published: June 2, 2020  Show citation