J Mov Disord.  2019 Jan;12(1):47-51. 10.14802/jmd.18032.

Treatment of Hemichoreoathetosis with Arrhythmic Proximal Tremor after Stroke: The Role of Zona Incerta as a Target for Deep Brain Stimulation

• Koerbel A
• do Amaral
• Zeh HB
• Wollmann E
• Koerbel RF
• Moro C
• Longo AL

• KMID: 2438679
• DOI: http://doi.org/10.14802/jmd.18032

Abstract

Deep brain stimulation (DBS) of the zona incerta has shown promising results in the reduction of medically refractory movement disorders. However, evidence supporting its efficacy in movement disorders secondary to hemorrhagic stroke or hemichoreoathetosis is limited. We describe a 48-year-old man who developed progressive hemichoreoathetosis with an arrhythmic, proximal tremor in his right arm following a thalamic hemorrhagic stroke. Pharmacological treatment was carried out with no change in the Abnormal Involuntary Movement Scale (AIMS) score after 4 weeks (14). After six sessions of botulinum toxin treatment, a subtle improvement in the AIMS score (13) was registered, but no clinical improvement was noted. The arrhythmic proximal movements were significantly improved after DBS of the zona incerta with a major decrease in the patient's AIMS score (8). The response to DBS occurring after the failure of pharmacological and botulinum toxin treatments suggests that zona incerta DBS may be an alternative for postthalamic hemorrhage movement disorders.

Keyword

Deep brain stimulation; zona incerta; hemorrhagic stroke; arrhythmic proximal tremor; hemichoreoathetosis; chorea

MeSH Terms

Abnormal Involuntary Movement Scale
Arm
Botulinum Toxins
Chorea
Deep Brain Stimulation*
Hemorrhage
Herpes Zoster*
Humans
Middle Aged
Movement Disorders
Stroke*
Tremor*
Zona Incerta*
Botulinum Toxins