E-ISSN: 1019-5157
ISSN: 2651-5024
Case Report
GPI Targeting for Holmes Tremor due to Hemorrhagic Cavernoma Located in the Subtalamic Nucleus
Selim Seker✉ ,
Mehmetzeki Yildiz ,
Mert Korkmak ,
Baran Yilmaz ,
Akin Akakin
Neurosurgery, Istinye University Hospital, Istanbul, Turkey
DOI: 10.5137/1019-5149.JTN.49340-25.5
Article in Press
Corresponding Author:
Selim Seker (selimseker1989@hotmail.com)
Abstract
Objective: We describe a rare case of Holmes tremor (HT) secondary to a hemorrhagic cavernoma and assess the effectiveness of deep brain stimulation (DBS), specifically targeting the globus pallidus internus (GPI), in the presence of coexisting dystonia.
Case Presentation: A 23-year-old female presented with several weeks of right-sided HT characterized by low-frequency proximal tremor, dystonia, and spasticity. Imaging revealed a left mesencephalic cavernoma with acute hemorrhage. Pharmacological treatmentsincluding levodopa and muscle relaxantsprovided no benefit. Due to her declining quality of life, she underwent awake unilateral GPI-DBS. Intraoperative stimulation produced immediate improvement in both tremor and dystonia without adverse effects. Postoperative follow-up demonstrated sustained clinical improvement and no complications.
Discussion: Medical therapy for HT is often challenging, and many patients require surgical management. The ventral intermediate nucleus (Vim) is the routine DBS target; however, its efficacy may be reduced in cases with thalamic involvement or coexisting dystonia. GPI-DBS, widely used in dystonia, presents an alternative by modulating basal ganglia outflow pathways.
Conclusions: This case supports GPI-DBS as an effective and feasible treatment option for HT, particularly when dystonia is a prominent feature.
Case Presentation: A 23-year-old female presented with several weeks of right-sided HT characterized by low-frequency proximal tremor, dystonia, and spasticity. Imaging revealed a left mesencephalic cavernoma with acute hemorrhage. Pharmacological treatmentsincluding levodopa and muscle relaxantsprovided no benefit. Due to her declining quality of life, she underwent awake unilateral GPI-DBS. Intraoperative stimulation produced immediate improvement in both tremor and dystonia without adverse effects. Postoperative follow-up demonstrated sustained clinical improvement and no complications.
Discussion: Medical therapy for HT is often challenging, and many patients require surgical management. The ventral intermediate nucleus (Vim) is the routine DBS target; however, its efficacy may be reduced in cases with thalamic involvement or coexisting dystonia. GPI-DBS, widely used in dystonia, presents an alternative by modulating basal ganglia outflow pathways.
Conclusions: This case supports GPI-DBS as an effective and feasible treatment option for HT, particularly when dystonia is a prominent feature.
Keywords
deep brain stimulation
tremor
dystonia
globus pallidus internus
Holmes tremor