Case reportFailed DBS for palliation of visual problems in a case of oculopalatal tremor
Introduction
Oculopalatal tremor (OPT), first described over 100 years ago as oculopalatal myoclonus [1], often presents as pendular nystagmus associated with a palatal tremor. Secondary cases of OPT typically follow acute brainstem lesions or vascular events [2]. Most reported cases involve continuous palatal tremor in association with vertical pendular nystagmus, though notable variations may include monocular, horizontal or torsional nystagmus, as well as involvement of other branchial-derived muscles [2]. The palliative treatment of visual problems associated with OPT by targeting red nucleus (RN) with DBS has not been previously explored. We present the case of a patient with OPT who had bilateral RN region DBS through an approach similar to STN DBS for Parkinson disease. The indication for therapy was the palliative treatment of visual difficulties.
Section snippets
Case report
A 44-year-old man with a history of a pontine cavernous malformation, which was previously surgically resected, presented after awakening with numbness in his hands, diplopia, and a feeling of generalized weakness. Magnetic resonance imaging (MRI) of his head revealed a new pontine hemorrhage. Followup MRI scans showed a persistent cavernous malformation in the pons, and this malformation was extracted by a vascular neurosurgeon.
Following this second surgical resection of the pontine cavernous
Discussion
Our attempt to regularize red nucleus firing through DBS failed to produce successful results in attenuating the OPT. This negative result may have been due to several factors, the most important being the side effects encountered when attempting to place the electrode into the RN region. The final measured coordinates of lead placement were discrepant from the planned coordinates mainly because of intraoperative adjustments due to patient discomfort. The dorsal and lateral placement and
References (4)
Pharyngeal and laryngeal nystagmus
Lancet
(1886)- et al.
Oculopalatal tremor with tardive ataxia
J Neuroophthalmol
(2001)
Cited by (13)
Subthalamic or red nucleus? A puzzling question arising during intraoperative recording for DBS
2017, Clinical NeurophysiologyEligibility Criteria for Deep Brain Stimulation in Parkinson's Disease, Tremor, and Dystonia
2016, Canadian Journal of Neurological SciencesNew-onset Oscillopsia in a Patient With a History of Pontine Stroke
2022, Journal of Neuro-OphthalmologyDeep brain stimulation as a palliative treatment for myorhythmia: A case of failure
2022, European Journal of NeurologyOncologic causes of oculopalatal tremors: neurophysiology and treatment
2021, Acta Neurologica BelgicaReal color model of a cadaver for deep brain stimulation of the subthalamic nucleus
2021, Applied Sciences (Switzerland)