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Tremor induced by thalamic deep brain stimulation in patients with complex regional facial pain

Authors

  • Constantine Constantoyannis MD, PhD,

    1. Surgical Centre for Movement Disorders, University of British Columbia, Vancouver, British Columbia, Canada
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  • Ajit Kumar MBBS, DM,

    1. Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
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  • A. Jon Stoessl MD, FRCP(C),

    1. Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
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  • Christopher R. Honey MD, DPhil, FRCS(C)

    Corresponding author
    1. Surgical Centre for Movement Disorders, University of British Columbia, Vancouver, British Columbia, Canada
    • Associate Professor, Division of Neurosurgery, University of British Columbia, Suite 325, 700 West 10th Avenue, Vancouver, BC, Canada V5Z 4E5
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  • A videotape accompanies this article.

Abstract

We report on two patients who developed a new postural and action tremor after chronic stimulation of the contralateral thalamus (VPM nucleus) during treatment of a complex regional facial pain syndrome. The tremor was only present during deep brain stimulation (DBS) and was suppressed with adjustment of the stimulation parameters. Tremor was seen only with low frequency stimulation (50 Hz or lower) and disappeared with higher stimulation frequencies. In addition to being an unusual side effect of thalamic DBS, we believe that this phenomenon affords insight into one possible mechanism underlying essential tremor (ET). A central oscillatory mechanism involving the olivocerebellar complex and the thalamus, which is a part of the cerebro–cerebello–cerebral circuit, is thought to play an important role in the genesis of ET. Induction of a tremor resembling ET in our patients indicates an active role for low frequency stimulation. A plausible explanation for this is that low frequency stimulation in the thalamic area enhances the output of the tremor-producing network. This leads credence to the concept of central oscillations in a “tremor circuit,” of which the thalamus is a part, as being important in ET. © 2004 Movement Disorder Society

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