BILATERAL THALAMIC DEEP BRAIN STIMULATION IN ADVANCED TREMOR-RIGID PARKINSON DISEASE: A CASE REPORT WITH MULTIMODAL CLINICAL AND STEREOTACTIC ASSESSMENT
Keywords:
Parkinson disease, deep brain stimulation, DBS, thalamus, ventrolateral thalamus, tremor, rigidity, stereotactic neurosurgery, MDS-UPDRS, neuromodulationAbstract
Background. Deep brain stimulation (DBS) is an established functional neurosurgical treatment for selected patients with Parkinson disease (PD) who develop disabling tremor, motor fluctuations, or insufficient symptom control despite optimized pharmacotherapy. We report a woman born in 1968 with PD diagnosed after symptom onset in 2016. Her phenotype was characterized by prominent resting and mixed tremor, hypokinesia, muscular rigidity, hypomimia, plastic hypertonia, freezing of gait, postural instability, propulsion, retropulsion, lateropulsion, recurrent falls, and progressive impairment of independent ambulation. The disease was classified as Hoehn–Yahr stage IV, with a Karnofsky Performance Status of 70.
Case Report. Despite intensive multidrug antiparkinsonian treatment, motor disability progressed. On August 28, 2025, the patient underwent bilateral DBS implantation targeting the posterior ventrolateral thalamic region as defined in the operative stereotactic protocol. A Zamorano–Duchovny frame was used with stereotactic MSCT acquisition, DICOM transfer to the navigation workstation, and Medtronic DBS planning software. Bilateral electrodes were implanted through 14-mm frontal-parietal burr holes and verified intraoperatively using C-arm fluoroscopy. The leads were connected to a pulse generator implanted in the right upper chest. Longitudinal outcome assessment was structured using MDS-UPDRS, Hoehn–Yahr staging, PDQ-39, MoCA, Berg Balance Scale, Timed Up and Go, Schwab and England ADL, and dopaminergic medication burden.
Conclusion. Bilateral thalamic DBS provided a rational neuromodulatory strategy for prominent medically refractory tremor in advanced PD. Multimodal assessment is essential for differentiating tremor suppression from changes in rigidity, bradykinesia, gait, balance, functional independence, and quality of life.
References
Kalia, L. V., & Lang, A. E. (2015). Parkinson’s disease. The Lancet, 386(9996), 896–912. https://doi.org/10.1016/S0140-6736(14)61393-3
Khodjieva D. T., Khaydarova D. K., Khaydarov N. K. Diagnosis and treatment of early stage parkinson's disease. European Journal of Research. 2017. P. 43-52
Simon, D. K., Tanner, C. M., & Brundin, P. (2020). Parkinson disease epidemiology, pathology, genetics, and pathophysiology. Clinics in Geriatric Medicine, 36(1), 1–12.
Khaydarova D.K., Mansurova N.A. Analysis of Motor Complications in Parkinson’s Disease Phenotypes. Journal of Advances in Medicine and Medical Research. 25(5): 1-7, 2018;
Deuschl, G., Schade-Brittinger, C., Krack, P., et al. (2006). A randomized trial of deep-brain stimulation for Parkinson’s disease. The New England Journal of Medicine, 355(9), 896–908.
Weaver, F. M., Follett, K., Stern, M., et al. (2009). Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease. JAMA, 301(1), 63–73.
Bronstein, J. M., Tagliati, M., Alterman, R. L., et al. (2011). Deep brain stimulation for Parkinson disease: An expert consensus and review of key issues. Archives of Neurology, 68(2), 165–171.
Lozano, A. M. (2000). Vim thalamic stimulation for tremor. Archives of Medical Research, 31(3), 266–269. https://doi.org/10.1016/S0188-4409(00)00081-3
Iorio-Morin, C., Fomenko, A., & Kalia, S. K. (2020). Deep-brain stimulation for essential tremor and other tremor syndromes: A narrative review of current targets and clinical outcomes. Brain Sciences, 10(12), 925. https://doi.org/10.3390/brainsci10120925
França, C., Carra, R. B., Diniz, J. M., Munhoz, R. P., & Cury, R. G. (2022). Deep brain stimulation in Parkinson’s disease: State of the art and future perspectives. Arquivos de Neuro-Psiquiatria, 80(5 Suppl 1), 105–115.
Лихачев, С. А., Ващилин, В. В., Буняк, А. Г., Алексеевец, В. В., & Забродец, Г. В. (2018). Глубокая стимуляция мозга у пациентов с болезнью Паркинсона: показания, порядок отбора, результаты лечения. Вестник Смоленской государственной медицинской академии, 17(1), 137–142.
Гусев, Е. И., Катунина, Е. А., & Титова, Н. В. (2016). Глубокая стимуляция мозга в лечении болезни Паркинсона. Вестник Росздравнадзора, 6, 54–60.
Ernst, M., Folkerts, A. K., Gollan, R., et al. (2023). Physical exercise for people with Parkinson’s disease: A systematic review and network meta-analysis. Cochrane Database of Systematic Reviews, 1, CD013856.
Naro, A., Pignolo, L., Sorbera, C., et al. (2020). A case-controlled pilot study on rhythmic auditory stimulation-assisted gait training and conventional physiotherapy in patients with Parkinson’s disease submitted to deep brain stimulation. Frontiers in Neurology, 11, 794.
Ferriero, G., Magro, V. M., Ferrara, P. E., Ariani, M., Coraci, D., Codazza, S., Maggi, L., & Ronconi, G. (2025). Deep-brain stimulation and intensive rehabilitation in a patient with Parkinson disease: A case report. American Journal of Case Reports, 26, e946308.
Naimov, O. Y., Matmurodov, R. J., & Muminov, B. A. (2025). Parkinson kasalligida motor fluktuatsiyalarni bemorlar psixoemotsional holati va yashash sifatiga ta’siri. O‘zbekiston tibbiyot ilmi, 4(5), 20–26.
Isroilova, G. M., Isroilova, G. Sh., Saifitdinkhuzhaev, Z. F., Nasirdinova, N. A., & Quchkarova, O. B. (2026). Parkinson kasalligida depressiya: bosqich va harakat yetishmovchiligining hal qiluvchi roli. Xalqaro ilmiy pediatriya jurnali, 5(1), 1228–1234.
Ризаев, Ж. А., Раимова, М. М., Бобоев, К. К., & Абдуллаева, М. Б. (2019). Паркинсон: таснифи, клиника ва даволаш асослари. Stomatologiya, 1(74), 64–67.
Collomb-Clerc, A., & Welter, M. L. (2015). Effects of deep brain stimulation on balance and gait in patients with Parkinson’s disease: A systematic neurophysiological review. Neurophysiologie Clinique/Clinical Neurophysiology, 45(4–5), 371–388.
Petersen, J. J., Kamp, C. B., Faltermeier, P., Juul, S., Løkkegaard, A., Gluud, C., & Jakobsen, J. C. (2024). Deep brain stimulation for Parkinson’s disease: Systematic review with meta-analysis and trial sequential analysis. BMJ Medicine, 3(1), e000705.
