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Deep brain stimulation of the thalamic ventral intermediate nucleus for Benedikt’s syndrome mainly present as tremor: a long-term case observation

  • Case Report - Functional Neurosurgery - Movement disorders
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Abstract

Benedikt’s syndrome (BS) is caused by the lesion in the midbrain and specifically manifests a series of symptoms, including ipsilateral third nerve palsy, contralateral tremor, hemiataxia, and hyperactive tendon reflexes. Deep brain stimulation (DBS) for BS emerges as a new approach and achieves successfully results. We report a successful case report of thalamic ventral intermediate (VIM) nucleus DBS for a patient with BS. During follow-up of 3 years, DBS successfully control the tremor and greatly improve his living and working quality. We consider that VIM DBS may have sustained benefit for refractory BS that mainly presents as tremor.

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Author notes

  1. Dr. Cheng, Yang and Wang contributed equally in this study as the co-first authors.

Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China

    Guoxiong Cheng

  2. Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan Province, China

    Yuan Yang & Yuelong Wang

  3. Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China

    Hongyu Tan

  4. Department of Neurosurgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China

    Shizhen Zhang

Authors
  1. Guoxiong Cheng
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  2. Yuan Yang
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  3. Yuelong Wang
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  4. Hongyu Tan
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  5. Shizhen Zhang
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Corresponding author

Correspondence to Shizhen Zhang.

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The authors declare that they have no conflict of interest.

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The patient has consented to submission of this case report to the journal.

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Comments

The authors of this interesting case report should be congratulated for the good clinical results achieved with a relative simple approach to midbrain (rubral tremor) in the context of “Benedict Syndrome” secondary to an hemorrhagic event.

Midbrain tremors are relatively rare, generally secondary to vascular event (ischaemia, AVM, cavernoma, etc.) but can be associated with multiple sclerosis, trauma tumours, and etc.

This form of tremor is generally unilateral, irregular, with frequence of 2-5 Hz and medically refractory.

Interruption of the cerebellar outflow is thought to be the primary pathophysiological cause and this form of tremor has both a proximal and distal component.

Beside the standard VIM/DBS stimulation for midbrain tremors (approach described by the authors) few new targeting strategies have been described with satisfactory long-term tremor control.

In our unit (Walton Centre Liverpool, UK), we approach this type of complex tremor with dual targeting; Zi/posterior subthalamic area utilizing an 8-contact lead. This approach allows flexibility for frequency of stimulation and the possibility of dual stimulation field for better tremor control.

Other authors have targeted the dento-rubro-thalamic tract with DTI integrated within the planning platform or multiple leads with dual targets.

Imaging improvement as well neuromodulation hardware improvement will allow in the years to come better results and a more standardised approach to this form of complex tremor.

Jibril Osman Farah

Liverpool UK

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Cheng, G., Yang, Y., Wang, Y. et al. Deep brain stimulation of the thalamic ventral intermediate nucleus for Benedikt’s syndrome mainly present as tremor: a long-term case observation. Acta Neurochir 160, 1349–1353 (2018). https://doi.org/10.1007/s00701-018-3526-8

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  • DOI: https://doi.org/10.1007/s00701-018-3526-8

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