{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T03:03:58Z","timestamp":1783825438435,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T00:00:00Z","timestamp":1671062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:p>Holmes tremor is a symptomatic tremor that develops secondary to central nervous system disorders. Stereotactic neuromodulation is considered when the tremors are intractable. Targeting the ventral intermediate nucleus (Vim) is common; however, the outcome is often unsatisfactory, and the posterior subthalamic area (PSA) is expected as alternative target. In this study, we report the case of a patient with intractable Holmes tremor who underwent dual-lead deep brain stimulation (DBS) to stimulate multiple locations in the PSA and thalamus. The patient was a 77-year-old female who complained of severe tremor in her left upper extremity that developed one year after her right thalamic infarction. Vim-thalamotomy using focused ultrasound therapy (FUS) was initially performed but failed to control tremor. Subsequently, we performed DBS using two leads to stimulate four different structures. Accordingly, one lead was implanted with the aim of targeting the ventral oralis nucleus (Vo)\/zona incerta (Zi), and the other with the aim of targeting the Vim\/prelemniscal radiation (Raprl). Electrode stimulation revealed that Raprl and Zi had obvious effects. Postoperatively, the patient achieved good tremor control without any side effects, which was maintained for two years. Considering that she demonstrated resting, postural, and intention\/action tremor, and Vim-thalamotomy by FUS was insufficient for tremor control, complicated pathogenesis was presumed in her symptoms including both the cerebellothalamic and the pallidothalamic pathways. Using the dual-lead DBS technique, we have more choices to adjust the stimulation at multiple sites, where different functional networks are connected. Intractable tremors, such as Holmes tremor, may have complicated pathology, therefore, modulating multiple pathological networks is necessary. We suggest that the dual-lead DBS (Vo\/Raprl and Vim\/Zi) presented here is safe, technically feasible, and possibly effective for the control of Holmes tremor.<\/jats:p>","DOI":"10.3389\/fnhum.2022.1065459","type":"journal-article","created":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T12:54:25Z","timestamp":1671108865000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["A case report: Dual-lead deep brain stimulation of the posterior subthalamic area and the thalamus was effective for Holmes tremor after unsuccessful focused ultrasound thalamotomy"],"prefix":"10.3389","volume":"16","author":[{"given":"Satoshi","family":"Maesawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Torii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Nakatsubo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Noda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Mutoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomotaka","family":"Ishizaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Tsuboi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Tanei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahisa","family":"Katsuno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuta","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,12,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1002\/mds.20862","article-title":"Postischemic delayed Holmes' tremor responding to low-dose cabergoline","volume":"21","author":"Akkus","year":"2006","journal-title":"Mov Disord."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e543","DOI":"10.1212\/WNL.0000000000005956","article-title":"DBS of the PSA and the VIM in essential tremor: a randomized, double-blind, crossover trial","volume":"91","author":"Barbe","year":"2018","journal-title":"Neurology"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/mds.27121","article-title":"Tremor task force of the international parkinson and movement disorder society. consensus statement on the classification of tremors from the task force on tremor of the International Parkinson and Movement Disorder Society","author":"Bhatia","year":"2018","journal-title":"Mov Disord 33"},{"key":"B4","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1093\/ons\/opx232","article-title":"Deep brain stimulation for essential tremor: aligning thalamic and posterior subthalamic targets in 1 surgical trajectory","volume":"15","author":"Bot","year":"2018","journal-title":"Oper Neurosurg (Hagerstown)."},{"key":"B5","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1007\/s00701-016-2725-4","article-title":"One-pass deep brain stimulation of dentato-rubro-thalamic tract and subthalamic nucleus for tremor-dominant or equivalent type Parkinson's disease","volume":"158","author":"Coenen","year":"2016","journal-title":"Acta Neurochir (Wien)."},{"key":"B6","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1212\/WNL.0000000000005076","article-title":"Double-target DBS for essential tremor: 8-contact lead for cZI and Vim aligned in the same trajectory","volume":"90","author":"Dos Santos Ghilardi","year":"2018","journal-title":"Neurology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1002\/mds.27463","article-title":"Comparison of tractography-assisted to atlas-based targeting for deep brain stimulation in essential tremor. Mov","volume":"33","author":"Fenoy","year":"2018","journal-title":"Disord"},{"key":"B8","doi-asserted-by":"publisher","first-page":"E445","DOI":"10.1227\/01.NEU.0000157104.87448.78","article-title":"Ventralis intermedius plus ventralis oralis anterior and posterior deep brain stimulation for posttraumatic Holmes tremor: two leads may be better than one: technical note","volume":"56","author":"Foote","year":"2005","journal-title":"Neurosurgery"},{"key":"B9","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1136\/jnnp-2011-300765","article-title":"Long term follow-up of deep brain stimulation of the caudal zona incerta for essential tremor","volume":"83","author":"Fytagoridis","year":"2012","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1007\/s00429-007-0170-0","article-title":"Human pallidothalamic and cerebellothalamic tracts: anatomical basis for functional stereotactic neurosurgery","volume":"212","author":"Gallay","year":"2008","journal-title":"Brain Struct Funct."},{"key":"B11","doi-asserted-by":"publisher","first-page":"18","DOI":"10.5334\/tohm.683","article-title":"Evolving concepts in our understanding and treatment of holmes tremor, over 100 years in the making","volume":"12","author":"Hey","year":"2022","journal-title":"Tremor Other Hyperkinet Mov (NY)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurom.2022.09.009","article-title":"Combined short-pulse and directional deep brain stimulation of the thalamic ventral intermediate area for essential tremor","author":"Hidding","year":"2022","journal-title":"Neuromodulation 22"},{"key":"B13","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.parkreldis.2019.03.028","article-title":"Mapping stimulation-induced beneficial and adverse effects in the subthalamic area of essential tremor patients","volume":"64","author":"Hidding","year":"2019","journal-title":"Parkinsonism Relat Disord."},{"key":"B14","doi-asserted-by":"publisher","first-page":"925","DOI":"10.3390\/brainsci10120925","article-title":"Deep-brain stimulation for essential tremor and other tremor syndromes: a narrative review of current targets and clinical outcomes","volume":"10","author":"Iorio-Morin","year":"2020","journal-title":"Brain Sci."},{"key":"B15","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1002\/ana.25618","article-title":"Mapping Holmes tremor circuit using the human brain connectome","volume":"86","author":"Joutsa","year":"2019","journal-title":"Ann Neurol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.3171\/2014.1.JNS12392","article-title":"Multitarget, dual-electrode deep brain stimulation of the thalamus and subthalamic area for treatment of Holmes' tremor","volume":"120","author":"Kobayashi","year":"2014","journal-title":"J Neurosurg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1227\/00006123-200205000-00003","article-title":"Head injury and posttraumatic movement disorders","volume":"50","author":"Krauss","year":"2002","journal-title":"Neurosurgery"},{"key":"B18","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1159\/000441393","article-title":"Prelemniscal radiations: a new reliable landmark of the thalamic nucleus ventralis intermedius location","volume":"93","author":"Lefranc","year":"2015","journal-title":"Stereotact. Funct. Neurosurg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.parkreldis.2017.12.014","article-title":"Deep brain stimulation for lesion-related tremors: a systematic review and meta-analysis","volume":"47","author":"Mendon\u00e7a","year":"2018","journal-title":"Parkinsonism Relat Disord."},{"key":"B20","doi-asserted-by":"publisher","first-page":"708","DOI":"10.3171\/jns.2003.99.4.0708","article-title":"Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor","volume":"99","author":"Murata","year":"2003","journal-title":"J Neurosurg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1111\/ner.12943","article-title":"Combined deep brain stimulation of subthalamic nucleus and ventral intermediate thalamic nucleus in tremor-dominant parkinson's disease using a parietal approach","volume":"22","author":"Neudorfer","year":"2019","journal-title":"Neuromodulation"},{"key":"B22","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/S1474-4422(17)30166-7","article-title":"Safety and efficacy of dual-lead thalamic deep brain stimulation for patients with treatment-refractory multiple sclerosis tremor: a single-centre, randomised, single-blind, pilot trial","volume":"16","author":"Oliveria","year":"2017","journal-title":"Lancet Neurol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1136\/jnnp.2006.112334","article-title":"Bilateral stimulation of the caudal zona incerta nucleus for tremor control","volume":"79","author":"Plaha","year":"2008","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B24","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1212\/WNL.0000000000002440","article-title":"Holmes tremor: clinical description, lesion localization, and treatment in a series of 29 cases","volume":"86","author":"Raina","year":"2016","journal-title":"Neurology"},{"key":"B25","volume-title":"Atlas for Stereotaxy of the Human Brain","author":"Schaltenbrand","year":"1977"},{"key":"B26","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1227\/00006123-200108000-00009","article-title":"Electrical stimulation of the prelemniscal radiation in the treatment of Parkinson's disease: an old target revised with new techniques","volume":"49","author":"Velasco","year":"2001","journal-title":"Neurosurgery"},{"key":"B27","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1002\/mds.10224","article-title":"Levodopa responsive rubral (Holmes) tremor","volume":"17","author":"Velez","year":"2002","journal-title":"Mov Disord."},{"key":"B28","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1002\/mds.870131309","article-title":"Pathology of symptomatic tremors","volume":"13","author":"Vidailhet","year":"1998","journal-title":"Mov Disord"},{"key":"B29","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1111\/ner.13220","article-title":"Therapeutic advances in the treatment of holmes tremor: systematic review","volume":"25","author":"Wang","year":"2022","journal-title":"Neuromodulation"},{"key":"B30","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1111\/joa.12132","article-title":"The anatomy of the caudal zona incerta in rodents and primates","volume":"224","author":"Watson","year":"2014","journal-title":"J Anat."}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2022.1065459\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,15]],"date-time":"2022-12-15T12:54:29Z","timestamp":1671108869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2022.1065459\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,15]]},"references-count":30,"alternative-id":["10.3389\/fnhum.2022.1065459"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2022.1065459","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,15]]},"article-number":"1065459"}}