LAUSR

BACKGROUND Dystonic tremor (DT) is defined as a tremor occurring in a body region affected by dystonia. The pathophysiological mechanisms behind DT are supposed to involve anomalies affecting the thalamic pallidal-receiving area (for the dystonic component) and the ventralis intermedius nucleus (Vim)-cortical loop (for the tremor component). Interest in Posterior Subthalamic Area (PSA) stimulation for various types of involuntary abnormal movements (IAMs) has arisen from recent positive results in patients affected by tremor refractory to Vim deep brain stimulation (DBS). CASE REPORT we describe the case of a 23-yo patient with a 15-years history of left upper limb DT due to a stroke in the right thalamus. He underwent DBS with single electrode passing through the right ventralis oralis anterior/ventralis oralis posterior (Voa/Vop) nuclei and the caudal zona incerta (cZI). Objective movement outcomes were assessed through the Unified Dystonia Rating Scale (UDRS) and the Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (FTM). The impact of tremor on activities of daily living (ADL) was assessed through the ADL-T24 questionnaire, while the quality of life (QOL) was assessed through the Quality of Life Scale (QOLS). All questionnaires were administered before DBS and at 5-year follow-up. UDRS and FTM scores dropped from 14.5 to 4.5 and from 46 to 7, respectively. ADL-T24 score turned from 19 to 3, while QOLS score turned from 49 to 82. CONCLUSIONS Stimulation of motor thalamus and cZI could be a viable treatment for those patients affected by tremor of various origins, further than DT, refractory to medical therapy.