Vim-Thalamic Deep Brain Stimulation for Cervical Dystonia and Upper-Limb Tremor: Quantification by Markerless-3D Kinematics and Accelerometry

Xenos L Mason; Katy A Cross; Ahmet Arac; Yvette Bordelon; Allan D Wu

doi:10.5334/tohm.673

Vim-Thalamic Deep Brain Stimulation for Cervical Dystonia and Upper-Limb Tremor: Quantification by Markerless-3D Kinematics and Accelerometry

Tremor Other Hyperkinet Mov (N Y). 2022 Mar 10:12:5. doi: 10.5334/tohm.673. eCollection 2022.

Authors

Xenos L Mason¹, Katy A Cross², Ahmet Arac², Yvette Bordelon², Allan D Wu³

Affiliations

¹ Departments of Neurological Surgery and Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA, US.
² Department of Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, US.
³ Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, US.

Abstract

Background: Deep Brain Stimulation (DBS) for dystonia is usually targeted to the globus pallidus internus (GPi), though stimulation of the ventral-intermediate nucleus of the thalamus (Vim) can be an effective treatment for phasic components of dystonia including tremor. We report on a patient who developed a syndrome of bilateral upper limb postural and action tremor and progressive cervical dystonia with both phasic and tonic components which were responsive to Vim DBS. We characterize and quantify this effect using markerless-3D-kinematics combined with accelerometry.

Methods: Stereo videography was used to record our subject in 3D. The DeepBehavior toolbox was applied to obtain timeseries of joint position for kinematic analysis [1]. Accelerometry was performed simultaneously for comparison with prior literature.

Results: Bilateral Vim DBS improved both dystonic tremor magnitude and tonic posturing. DBS of the hemisphere contralateral to the direction of dystonic head rotation (left Vim) had greater efficacy. Assessment of tremor magnitude by 3D-kinematics was concordant with accelerometry and was able to quantify tonic dystonic posturing.

Discussion: In this case, Vim DBS treated both cervical dystonic tremor and dystonic posturing. Markerless-3D-kinematics should be further studied as a method of quantifying and characterizing tremor and dystonia.

Keywords: Accelerometry; Deep Brain Stimulation; Dystonia; Kinematics; Tremor; Ventral Thalamic Nuclei.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

MeSH terms

Accelerometry
Biomechanical Phenomena
Deep Brain Stimulation* / methods
Dystonic Disorders* / therapy
Humans
Thalamus
Torticollis* / therapy
Tremor / therapy
Ventral Thalamic Nuclei / physiology

Grants and funding

This study was funded by the University of California, Los Angeles, and the U.S. Department of Veterans Affairs.