PMC6125736_01
Case 1. Pre-deep brain stimulation (DBS). The patient had almost immediate onset of orthostatic leg tremors on standing and had extreme difficulty standing without holding on to the table or walls. Post DBS (10 months). The patient demonstrates no visible tremor on standing, and has no difficulty at all standing in place without support.. Case 2. Pre-deep brain stimulation (DBS). Note buckling of the knees and severe difficulty standing in place because of severe orthostatic leg tremors that were apparent immediately upon standing. The patient requires assistance from one person to remain standing in place and intermittently with slow ambulation. Post DBS (1 month). There is improvement of the buckling of the knees on standing with little orthostatic leg tremor noted. The patient can stand better on his own or with a cane.
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The Talairach coordinates were (+-13.25, -6.75, 0) (Figure 1B).
Imaging of Lead Placement. (A) Case 1. Preoperative magnetic resonance imaging and post-lead intraoperative computed tomography (CT) scan are co-registered using Medtronic FrameLink software. Targeted contacts are contact 1 on the left (L1) and contact 9 on the right (R2). On the left, the stereotactic error of contact 1 is 1.1 mm from the intended target (-14.25, 6.35, 0). On the right, the stereotactic error of contact 9 is 1.1 mm from the intended target (-14.25, 6.35, 0) (active contacts: left, case(+), 1-, 3-; right, 11+, 9-, 10-). (B) Case 2. Intraoperative post-lead placement CT shows the position of contact 2 on the left ventralis intermedius (VIM) lead (L2), and contact 9 on the right VIM lead (R2). Contact 2 has a radial error of 0.9 mm off of the stereotactic plan targeting (-13.5, -6.75, 0). Contact 9 has a radial error of 0.7 mm off of the stereotactic plan targeting (13.5, -6.75, 0) (active contact: left, case(+), 2-; right, 11+, 8-,10-; contact 9 is shown because it is between contacts 8 and 10.
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Surface EMG recordings were performed at 10 months post DBS, with marked improvement of his OT with the stimulator on compared with that when the stimulator was off (Figures 2A,B).
PMC6125736_02
Case 1. Pre-deep brain stimulation (DBS). The patient had almost immediate onset of orthostatic leg tremors on standing and had extreme difficulty standing without holding on to the table or walls. Post DBS (10 months). The patient demonstrates no visible tremor on standing, and has no difficulty at all standing in place without support.. Case 2. Pre-deep brain stimulation (DBS). Note buckling of the knees and severe difficulty standing in place because of severe orthostatic leg tremors that were apparent immediately upon standing. The patient requires assistance from one person to remain standing in place and intermittently with slow ambulation. Post DBS (1 month). There is improvement of the buckling of the knees on standing with little orthostatic leg tremor noted. The patient can stand better on his own or with a cane.
.jpg
PMC6125736_02_.jpg
v01
The Talairach coordinates were (+-13.25, -6.75, 0) (Figure 1B).