Rescue Thalamotomy for Habituation to Deep Brain Stimulation in Essential Tremor: Case Report.

BACKGROUND

Habituation to deep brain stimulation (DBS) remains a therapeutic challenge in essential tremor (ET), with 4-42% of patients experiencing progressive loss of benefit.

CASE REPORT: A 68-year-old man with ET presented with debilitating bilateral tremor. The patient underwent bilateral DBS to posterior subthalamic area (PSA). Despite initial tremor relief, symptoms gradually recurred three months later. After 12 months of unsuccessful programming, the patient underwent left-sided radiofrequency Vim thalamotomy. Due to severe tremor rebound phenomenon, tremor control was achieved in 1.5 months.

DISCUSSION: To our knowledge, this study represents the first report of successful thalamotomy performed for PSA-DBS habituation, accompanied by delayed postoperative tremor improvement. The clinical trajectory and putative mechanisms underlying both habituation and lesion-induced tremor suppression are discussed based on imaging analysis.