Objective: To investigate the efficacy of DBS on drug-resistant tremor secondary to alterations of the cerebellum or the dentato-rubro-thalamic pathways.

Background: Deep Brain Stimulation (DBS) in the ventral intermediate (Vim), in the ventro-oralis posterior/ventro-oralis-anterior (Vop/Voa) nuclei of the thalamus and in the Zona Incerta/ Preleminscal radiation (Zi/RaPl) has been proposed in the treatment of cerebellar symptoms, mainly tremor. Vim, Vop and Voa are main relais on the dentate-rubro-thalamic pathways and, in addition, collect important direct afferents from cerebellum, in part running into the RaPl; so far, these targets are considered part of the cerebello-thalamic-cortical loop which impinges both on posture and on voluntary movements.

Methods: We report two cases of cerebellar symptoms occurred in young patients. A 23 years-old male after a severe head trauma developed bilateral intention tremor, trunk ataxia, dysmetria, dysdiadokinesia. MRI showed diffuse axonal injuries with lesions in dentate nuclei, cerebellar peduncles and mesencephalon. Treatment with primidone was unsuccessfull. The other was a 27 years –old male affected from MS; he suffered for severe intention tremor; MRi showed signal alterations into the cerebellar peduncles and in the anterior portion of thalamic body (i.e anterior thalamic nuclei). According to the anatomical lesions, the targets were chosen in the anterior portion of Vim/posterior portion of Vop in the first case and Vop/Zi/RaPl in the second case; intraoperative semi-microstimulation and recordings were performed to obtain tremor abolition and to record the drive of “tremor cells” and typical bursts activity of Vim/Vop.

Results: In both the cases tremor significantly improved since the first weeks after surgery, as the reglage of the stimulation became more effective; during the same time, also dysmetria and dysdiadokinesia of the first patient improved progressively. After 2 years movements are more flowing and accurate and tremor is completely controlled from stimulation in both the patients.

Conclusions: Our findings confirm that Voa/Vop and Zi/RaPl DBS may control cerebellar tremor and other cerebellar symptoms; moreover, more cases and longer follow-up will highlight the effective worth of this indication.

Preliminary data presented to the Congress of Società Italiana di Neurochirurgia SINch, Napoli, June 2015.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-in-the-treatment-of-cerebellar-tremor-in-young-patients/