Cerebellum DOI 10.1007/s12311-013-0546-z

ORIGINAL PAPER

Targeting the Red Nucleus for Cerebellar Tremor M. Lefranc & M. Manto & P. Merle & M. Tir & D. Montpellier & J.-M. Constant & D. Le Gars & J.-M. Macron & P. Krystkowiak

# Springer Science+Business Media New York 2014

Abstract Deep brain stimulation of the thalamus (and especially the ventral intermediate nucleus) does not significantly improve a drug-resistant, disabling cerebellar tremor. The dentato-rubro-olivary tract (Guillain-Mollaret triangle, including the red nucleus) is a subcortical loop that is critically involved in tremor genesis. We report the case of a 48-year-old female patient presenting with generalized cerebellar tremor caused by alcohol-related cerebellar degeneration. Resistance to pharmacological treatment and the severity of the symptoms prompted us to investigate the effects of bilateral deep brain stimulation of the red nucleus. Intra-operative microrecordings of the red nucleus revealed intense, irregular, tonic background activity but no rhythmic components that were synchronous with upper limb tremor. The postural component of the cerebellar tremor disappeared during insertion of the macro-electrodes and for a few minutes after stimulation, with no changes in the intentional (kinetic) component. Stimulation per se did not reduce postural or intentional tremor and was associated with dysautonomic symptoms (the voltage

threshold for which was inversed related to the stimulation frequency). Our observations suggest that the red nucleus is (1) an important centre for the genesis of cerebellar tremor and thus (2) a possible target for drug-refractory tremor. Future research must determine how neuromodulation of the red nucleus can best be implemented in patients with cerebellar degeneration. Keywords Red nucleus . Deep brain stimulation . Cerebellar tremor . Neuromodulation

Introduction Deep brain stimulation (DBS) of the thalamus (and especially the ventral intermediate nucleus—the VIM, defined according to Hassler’s classification) [1] is effective in the treatment of many tremor syndromes, including those related to Parkinson’s disease (PD) [2] and essential tremor [3, 4].

Electronic supplementary material The online version of this article (doi:10.1007/s12311-013-0546-z) contains supplementary material, which is available to authorized users. M. Lefranc (*) : D. Le Gars Department of Neurosurgery, Amiens University Hospital, Amiens, France e-mail: [email protected]

D. Montpellier Department of Anaesthesiology, Amiens University Hospital, Amiens, France

P. Merle : J.

Targeting the red nucleus for cerebellar tremor.

Deep brain stimulation of the thalamus (and especially the ventral intermediate nucleus) does not significantly improve a drug-resistant, disabling ce...
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