Objective: This study describes our center’s experience with 26 patients who underwent surgery for thalamic ventral intermediate nucleus (VIM) stimulation between years 2008-2018

Background: Deep-brain stimulation (DBS) is an established treatment for medically refractory tremor. Although there are known complications associated with the treatment especially in the long term.

Method: A retrospective analysis based on medical records of consecutive patients with medically refractory tremor of different etiologies that went through VIM-DBS surgery.

Results: Out of 26 patients (16 males, ages 65±9.51 years at surgery) 17 had ET, 5 had PD, 2 had ET/PD, 1 had dystonic head tremor and 1 had cerebellar tremor,  14 went through bilateral and 12 unilateral VIM-DBS surgery. The duration of follow up ranged from 1 to 11 years, mean: 5±2.76 years. 20 patients showed significant initial improvement of tremor but 5 had some recurrence of tremor in the long term despite continued DBS and well-located electrodes. The complications consisted of 2 patients with an IPG infection leading to removal of DBS system, 4 patients developed a cerebellar syndrome, 4 patients -dysarthria, and 2 of these turned off their IPG because of stimulation-induced side effects. 3 patients had to go through a second surgery because of displaced electrodes.

Conclusion: Based on our experience and in correlation with other studies in the literature VIM DBS may have limited effects in the long term. In these cases other alternative may be considered, such as unilateral focused ultrasound thalamotomy in order to relieve tremor of the dominant hand.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/vim-stimulation-for-refractory-tremor-the-sheba-experience/