• Kazutaka Kobayashi, Yoichi Katayama, Koichiro Sumi, Toshiharu Otaka, Toshiki Obuchi, Toshikazu Kano, Takafumi Nagaoka, Hideki Oshima, Chikashi Fukaya, Takamitsu Yamamoto, and Hideki Atsumi.
• Department of Neurological Surgery and Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan; and Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
• Neuromodulation. 2010 Jan 1;13(1):31-6.

AbstractIntroduction. Chronic thalamic stimulation has been confirmed as an effective treatment for tremor. The optimal target has been commonly accepted to be situated within the ventral thalamus, but a standard trajectory of the deep brain stimulation (DBS) electrode has not yet been established. Materials and Methods. A 53-year-old man with an 11-year history of essential tremor was treated by DBS of the thalamus. In this patient, we had a chance to compare the effects of different trajectory angles of the DBS electrode on tremor. Results. Intraoperative stimulation with the DBS electrode temporarily inserted at a high angle to the horizontal plane of the anterior commissure-posterior commissure (AC-PC) line to cover only the nucleus ventralis intermedius (Vim) was not effective. In contrast, stimulation with the DBS electrode permanently implanted at a low angle, covering a wide area extending from the nucleus ventralis oralis (Vo) to the Vim, reduced the tremor. Conclusion. We report on the case of a patient who showed different effects on tremor depending on the trajectory angle of the DBS electrode to the AC-PC line. The insertion trajectory of the DBS electrode may be an important factor for the treatment of tremor.© 2009 International Neuromodulation Society.

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