Head
tremor in patients with
dystonia is referred to as dystonic
tremor. During surgical treatment, numerous targets may be selected, including the internal segment of the globus pallidus and the ventral intermediate (Vim) nucleus; however, there is no consensus concerning the most effective treatment target. We report herein a case of dystonic head
tremor in which improvement persisted for 5 years after
deep brain stimulation (DBS) of the bilateral thalamic Vim and ventro-oral internus (Voi) nuclei. The patient, a 67-year-old woman, has a horizontal head
tremor associated with
cervical dystonia that had been resistant to
drug treatment over 3 years. Immediately following surgery,
dystonia and
tremor symptoms had completely improved. Voice volume declined and
dysarthria occurred but improved upon adjusting the stimulation conditions. Over 5 years, both head
tremor and
cervical dystonia have been completely controlled, and no other obvious complications have been observed. As the Voi nucleus receives pallidothalamic projections involved in
dystonia and the Vim nucleus receives cerebellothalamic projections involved in
tremors, stimulating these 2 nuclei with the same
electrode appears reasonable in the treatment of dystonic
tremor. This case suggests that Vim-Voi DBS may be effective for treating dystonic head
tremor.