Objective: We report on a 54 year old female with essential tremor (ET), bilateral deep brain stimulation (DBS) of the caudal zona incerta (CZi) who was noted to have an improvement of her gait stability after DBS reprogramming.

Background: Deep brain stimulation (DBS) of the ventral intermediate nucleus of thalamus has been shown to be effective in controlling hand tremors, but may be less effective for head and truncal tremor. Caudal Zi (CZi) DBS has been reported to be effective in axial and proximal tremor without worsening gait. In our case, we hypothesize that improvement of the patient’s truncal tremor with an increase of bilateral DBS current on DBS CZi programming improved the patient’s gait stability.

Methods: This is a case report.

Results: We report on a 54 year old female with essential tremor (ET), bilateral deep brain stimulation (DBS) of the caudal zona incerta (CZi) who was noted to have an improvement of her gait stability after DBS reprogramming. The patient has a longstanding history of ET and underwent bilateral DBS CZi surgery a year ago with excellent tremor control. She denied a history of truncal tremor. She was noted for the past month to have a significant worsening of her gait instability, in which she felt unsteady when walking and was having frequent falls. On exam with DBS OFF, the patient was noted to have moderate head tremor, moderate action tremor in bilateral hands and mild voice tremor, with a wide based gait and inability to tandem walk with some truncal sway. On standing, she was noted to have a truncal tremor. With the DBS stimulation ON and bilateral current mildly increased, the patient was found to have no head tremor, no action tremor of the right hand and very mild action tremor of her left hand. She did not have truncal tremor on standing and had a more narrow based gait. She was able to tandem walk with mild difficulty.

Conclusions: We hypothesize that improvement of the patient’s truncal tremor with an increase of bilateral DBS current on DBS CZi programming improved the patient’s gait stability.

References: Fytagordis A, Sandvik U et al. Long term follow-up of deep brain stimulation of the caudal zona incerta for essential tremor. J Neurol Neurosurgery Psychiatry. 2012;83(3):258-62.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-dbs-of-the-caudal-zona-incerta-improving-gait-stability-and-truncal-tremor-in-a-patient-with-essential-tremor/