Deep brain stimulation as an effective treatment option for post–midbrain infarction-related tremor as it presents with Benedikt syndrome

Case report

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  • 1 Stritch School of Medicine, and
  • 2 Departments of Neurological Surgery and
  • 3 Neurology, Loyola University Health System, Maywood, Illinois
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Benedikt syndrome is a rare but debilitating constellation of symptoms that manifests from infarction of the red nucleus, cerebral peduncle, oculomotor fascicles, and lower oculomotor nucleus. Clinically, it presents as ipsilateral cranial nerve III palsy, contralateral hemiataxia with intention tremor, contralateral hemiparesis, and hyperactive tendon reflexes. Commonly, the tremor upon purposeful movement proves to be the most debilitating manifestation of the infarction with significant impact on the patient's ability to perform activities of daily living and, therefore, quality of life. The authors report the successful management of this debilitating post–midbrain infarction tremor with the insertion of a deep brain stimulator with targets in the contralateral lenticular fasciculus.

Abbreviations used in this paper: AC = anterior commissure; DBS = deep brain stimulation; PC = posterior commissure; Vim = ventral intermediate; WHIGET = Washington Heights–Inswood Genetic Study of Essential Tremor.

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Contributor Notes

Address correspondence to: Douglas Anderson, M.D., Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois 60153. email: dander1@lumc.edu.
  • 1

    Anderson WS, & Lenz FA: Surgery insight: Deep brain stimulation for movement disorders. Nat Clin Pract Neurol 2:310 320, 2006

  • 2

    Andy OJ, , Jurko MF, & Sias FR Jr: Subthalamotomy in treatment of parkinsonian tremor. J Neurosurg 20:860870, 1963

  • 3

    Benabid AL, , Pollak P, , Gervason C, , Hoffmann D, , Gao DM, & Hommel M, : Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet 337:403406, 1991

    • Search Google Scholar
    • Export Citation
  • 4

    Benabid AL, , Pollak P, , Louveau A, , Henry S, & de Rougemont J: Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol 50:344346, 1987

    • Search Google Scholar
    • Export Citation
  • 5

    Deuschl G, , Raethjen J, , Lindemann M, & Krack P: The pathophysiology of tremor. Muscle Nerve 24:716735, 2001

  • 6

    Duncan GW, & Weindling SM: Posterior cerebral artery stenosis with midbrain infarction. Stroke 26:900902, 1995

  • 7

    Gildenberg PL, Stereotactic surgery: present and past. Heilbrun MP: Concepts in Neurosurgery: Stereotactic Neurosurgery Baltimore, Williams & Wilkins, 1988. 115

    • Search Google Scholar
    • Export Citation
  • 8

    Goto S, & Yamada K: Combination of thalamic Vim stimulation and GPi pallidotomy synergistically abolishes Holmes' tremor. J Neurol Neurosurg Psychiatry 75:12031204, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Gross RE, & Lozano AM: Advances in neurostimulation for movement disorders. Neurol Res 22:247258, 200

  • 10

    Israel Z: Surgery for tremor. Isr Med Assoc J 5:727730, 2003

  • 11

    Jikumaru M, , Masuda T, , Ueyama H, , Sannomiya K, & Kuymamoto T: Bilateral medial medullary infarction presenting as vertical gaze palsy. Rinsho Shingeigaku 46:4549, 2006

    • Search Google Scholar
    • Export Citation
  • 12

    Kitagawa M, , Murata J, , Kikuchi S, , Sawamura Y, , Saito H, & Sasaki H, : Deep brain stimulation of subthalamic area for severe proximal tremor. Neurology 55:114116, 2000

    • Search Google Scholar
    • Export Citation
  • 13

    Louis ED, , Barnes L, , Wendt KJ, , Ford B, , Sangiorgio M, & Tabbal S, : A teaching videotape for the assessment of essential tremor. Mov Disord 16:8993, 2001

    • Search Google Scholar
    • Export Citation
  • 14

    Miocinovic S, , Parent M, , Butson CR, , Hahn PJ, , Russo GS, & Vitek JL, : Computational analysis of subthalamic nucleus and lenticular fasciculus activation during therapeutic deep brain stimulation. J Neurophysiol 96:15691580, 2006

    • Search Google Scholar
    • Export Citation
  • 15

    Miyagi Y, , Shima F, , Ishido K, , Moriguchi M, & Kamikaseda K: Posteroventral pallidotomy for midbrain tremor after a pontine hemorrhage. Case report. J Neurosurg 91:885888, 1999

    • Search Google Scholar
    • Export Citation
  • 16

    Pahwa R, , Lyons KE, , Wilkinson SB, , Simpson RK Jr, , Ondo WG, & Tarsy D, : Long-term evaluation of deep brain stimulation of the thalamus. J Neurosurg 104:506512, 2006

    • Search Google Scholar
    • Export Citation
  • 17

    Payne MS, , Brown BL, , Rao J, & Payne BR: Treatment of phenylketonuria-associated tremor with deep brain stimulation: case report. Neurosurgery 56:E868, 2005

    • Search Google Scholar
    • Export Citation
  • 18

    Prensa L, , Cossette M, & Parent A: Dopaminergic innervation of human basal ganglia. J Chem Neuroanat 20:207213, 2000

  • 19

    Quinn N, & Bhatia K: Functional neurosurgery for Parkinson's disease. Has come a long way, though much remains experimental. BMJ 316:12591260, 1998

    • Search Google Scholar
    • Export Citation
  • 20

    Rehncrona S, , Johnels B, , Widner H, , Tornqvist AL, , Hariz M, & Sydow O: Long-term efficacy of thalamic deep brain stimulation for tremor: double-blind assessments. Mov Disord 18:163170, 2003

    • Search Google Scholar
    • Export Citation
  • 21

    Schuurman PR, , Bosch DA, , Bossuyt PM, , Bonsel GJ, , van Someren EJ, & de Bie RM, : A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med 342:461468, 2000

    • Search Google Scholar
    • Export Citation
  • 22

    Skidmore FM, , Rodriguez RL, , Fernandez HH, , Goodman WK, , Foote KD, & Okun MS: Lessons learned in deep brain stimulation for movement and neuropsychiatric disorders. CNS Spectr 11:521536, 2006

    • Search Google Scholar
    • Export Citation
  • 23

    Spiegel EA, , Wycis HT, & Freed H: Thalamotomy in mental disorders. AMA Arch Neurol Psychiatry 64:595598, 1950

  • 24

    Spiegel EA, , Wycis HT, , Szekely EG, , Adams DJ, , Flanagan M, & Baird HW III: Campotomy in Various Extrapyramidal Disorders. J Neurosurg 20:871884, 1963

    • Search Google Scholar
    • Export Citation
  • 25

    Starr PA, , Vitek JL, , DeLong M, & Bakay RA: Magnetic resonance imaging-based stereotactic localization of the globus pallidus and subthalamic nucleus. Neurosurgery 44:303314, 1999

    • Search Google Scholar
    • Export Citation
  • 26

    Talairach J, & Tournoux P: Co-Planar Stereotaxic Atlas of the Human Brain Stuttgart, Georg Thieme Verlag, 1988. 8081

  • 27

    Velasco FC, , Molina-Negro P, , Bertrand C, & Hardy J: Further definition of the subthalamic target for arrest of tremor. J Neurosurg 36:184191, 1972

    • Search Google Scholar
    • Export Citation
  • 28

    Walker AE, Stereotaxic surgery for tremor. Schaltenbrand G, & Walker AE: Stereotaxy of the Human Brain ed 2 Stuttgart, Georg Thieme Verlag, 1982. 515521

    • Search Google Scholar
    • Export Citation
  • 29

    Yelnik J, , Damier P, , Demeret S, , Gervais D, , Bardinet E, & Bejjani BP, : Localization of stimulating electrodes in patients with Parkinson disease by using a three-dimensional atlasmagnetic resonance imaging coregistration method. J Neurosurg 99:8999, 2003

    • Search Google Scholar
    • Export Citation

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