Objective: To present a case of Homes’s tremor (HT) caused by head trauma who improved significantly after dual electrode implantation.

Background: Holmes’ tremor (HS) is characterized by large and irregular amplitude, low frequency(<3–4 Hz) rest as well as prominent action and postural tremors, with tremor often affecting predominantly the proximal upper extremity. The medical treatment of HT is complex and often unsatisfactory.

Method: A 23-year-old right-handed man presented to Mersin University, Neurology Department with a severe right upper extremity tremor after a long period of hospitalization including intensive care unit due to a car accident in a different center. Brain magnetic resonance imaging (MRI) showed hyperintensity in the mesencephalon due to sequelae of the contusion.  
On neurological examination we observed bilateral postural, kinetic, intentional ve resting tremor in both upper extremities but the severity was significantly high in the right arm. The tremor frequency was 4 Hz. Phenomenologically, the tremor had rest, postural, kinetic and intentional components and also affected the proximal part. There were also dystonic components. The Tremor rating scale total score was 80. The tremor in the right arm was severe enough that the patient can not use right arm for daily activities. Because the tremor did not respond to medical treatment, bilateral DBS of the Vim was offered to the patient and consent was taken prior to stereotactic surgery. The surgical targets were bilateral Vim.  The electrodes were activated seven days after the surgery. After an adequate clinical monitoring and DBS programming , it was decided to implant an electrode on the left GPI for the right extremity, as the patient did not show a marked improvement in right arm tremor. After taking the consent from the patient right Vim electrode was removed and a new electrode was implanted in the right Gpi.

Results: After The optimization of the programing parameters in two weeks  the patient showed significant improvement in the tremor severity. The final TRS total score at last visit was 30 showing 70% decrement of the tremor severity.

Conclusion: We think that in addition to Vim stimulation for controlling distal tremors, GPi is a good target for controlling proximal tremor when dystonia accompanied.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unilateral-thalamic-vim-and-gpi-stimulation-for-the-treatment-of-holmes-tremor-caused-by-trauma/