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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Deep brain stimulation of the VOA for dystonic-jerky-unsteady-hand syndrome: case report

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  • D. Falk - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie
  • N. Warneke - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie
  • F. Köpper - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurologie
  • J. Volkmann - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurologie
  • H. Mehdorn - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP07-11

doi: 10.3205/09dgnc327, urn:nbn:de:0183-09dgnc3270

Published: May 20, 2009

© 2009 Falk et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: In the literature data of deep brain stimulation for post stroke dystonia are rare. Due to disappointing benefits after single target stimulation multiple targets are discussed.

Methods: We report one patient with a dystonic-jerky-unsteady-hand-syndrome, which presented with tremor and hyperkinetic movements of the right arm. MRI findings were ischemic lesions of the left thalamus and both cerebellar hemispheres. Due to the failure of noninvasive therapy we planned the unilateral stimulation of the left nucleus ventralis oralis anterior (VOA) and the globus pallidus internus (GPI). The surgery was performed using stereotactic MRI and multiple trajectories for microrecording and macrostimulation under local anesthesia.

Results: Along the trajectory for the VOA we found good thalamic activity. A good reduction of the symptoms was shown under macrostimulation without relevant side effects. Owing to this impressive effect GPI stimulation was not performed. Under permanent stimulation improvement with up to complete reduction of tremor and dystonic movements was achieved from the first day of stimulation and over the half-year follow-up.

Conclusions: We conclude that the deep brain stimulation of the VOA could be an effective method for the treatment of post-stroke tremor and dystonia. Although the effect cannot be predictable, the planning of a second target could be helpful.