{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:53:21Z","timestamp":1785808401706,"version":"3.56.0"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T00:00:00Z","timestamp":1692662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Thalamic deep brain stimulation (DBS) is established for medically refractory tremor syndromes and globus pallidus stimulation (GPi\u2010DBS) for medically refractory dystonia syndromes. For combined tremor and dystonia syndromes, the best target is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We present four patients with two different profiles whose clinical course demonstrates that our current analysis of clinical symptomatology is not a sufficient predictor of surgical success.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Outcome parameters were assessed with observer\u2010blinded video ratings and included the Fahn\u2010Tolosa\u2010Marin\u2010Tremor Rating Scale (FTM\u2010TRS) and the Unified Dystonia Rating Scale (UDRS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two patients with \u201cpredominant lateralized action tremor\u201d of the hands and mild cervical dystonia showed no relevant tremor improvement after GPi\u2010DBS, but UDRS improved (mean, 45%). Rescue ventral intermediate nucleus of the thalamus (Vim)\u2010DBS electrodes were implanted and both patients benefited significantly with a mean tremor reduction of 51%.<\/jats:p><jats:p>Two other patients with \u201caxial\u2010predominant action tremor of the trunk and head\u201d associated with cervical dystonia underwent bilateral Vim\u2010DBS implantation with little effect on tremor (24% reduction in mean FTM\u2010TRS total score) and no effect on dystonic symptoms. GPi rescue DBS was implanted and showed a significant effect on tremor (63% reduction in mean FTM\u2010TRS) and dystonia (49% reduction in UDRS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The diagnosis of dystonic tremor alone is not a sufficient predictor to establish the differential indication of GPi\u2010 or Vim\u2010DBS. Further criteria (eg, proximal\u2010distal distribution of tremor\/dystonia) are needed to avoid rescue surgery in the future. On the other hand, the course of our patients encourages rescue surgery in such severely disabled patients if the first target fails.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.13846","type":"journal-article","created":{"date-parts":[[2023,7,29]],"date-time":"2023-07-29T03:49:39Z","timestamp":1690602579000},"page":"1478-1484","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The Challenge of Choosing the Right Stimulation Target for Dystonic Tremor\u2014A Series of Instructive Cases"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9306-8332","authenticated-orcid":false,"given":"Steffen","family":"Paschen","sequence":"first","affiliation":[{"name":"Department of Neurology University Hospital Schleswig\u2010Holstein, Campus Kiel and Christian Albrechts\u2010University of Kiel  Kiel Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos 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