PMC8769394_01
(A-C) T2-weighted MR images of the cerebellum, thalamus, and cerebrum. A slightly hyperintense spot is seen in the right dentate gyrus (arrow, A). Hyperintense spots are also seen in the left thalamus (arrow, B), and bilateral subcortical white matter (arrows, C). (D) Microelectrode recordings in the ventral tier of the thalamus showing activity of the rhythmic tremor cells (top) and random burst cells (bottom) responding to kinetic motions. MR: magnetic resonance.
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T2-weighted magnetic resonance (MR) images did not show apparent brain lesions, although there were slightly hyperintense spot in the right dentate gyrus, and hyperintense spots in the left thalamus, and bilateral subcortical white matter on T2-weighted MR images (Figs. 1A-1C). The tremor of the present case seemed to be similar to Holmes tremor; however, the activation of tremor by posture was not compatible with the typical presentation of Holmes tremor. Therefore, the present tremor was considered to be atypical. The arrayed microelectrodes recorded spiking activity from the tremor and kinesthetic cells in the Vop and Vim (Fig. 1D).
(A) Bilateral thalamic DBS electrodes (arrowheads) are shown on postoperative computed tomography fused with T1-weighted MR image. Sagittal (B) and coronal (C) images of the DBS leads. (D) Reconstruction of DBS leads in the nucleus Vop and nucleus Vim of the thalamus. The DBS leads go through the border (arrows) between the Vop and Vim. The volume of activated tissue by bipolar stimulation is shown around a cathode of contact #2 and an anode of contact #1 (red). RN: red nucleus, STN: subthalamic nucleus, Vim: ventralis intermedius, Voa: ventralis oralis anterior, Vop: ventralis oralis posterior.
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Accordingly, the DBS leads (model 3387; Medtronic, Minneapolis, MN, USA) were implanted bilaterally as they crossed the Vop/Vim border (Figs. 2A-2C). On the DISTAL (DBS Intrinsic Template AtLas) atlas, the contacts #2 and #1 were localized within the Vop and Vim, respectively (Fig. 2D). The volume of activated tissue adequately covered the Vop/Vim border (Fig. 2D).