Quantification of Tremor from Movement Trajectories in Radiofrequency Subthalamotomy: A Case Report

Abstract

Objective: To describe the effect of bilateral radiofrequency (RF) subthalamotomy by quantifying hand tremor from movement trajectories.
Case report: 83-year-old female patient, with a history of chronic obstructive pulmonary disease, low weight (BMI: 16) and Parkinson's Disease (PD) Hoehn & Yahr II. She had 5 years of tremor at rest, high frequency and large amplitude, predominantly in the right hand with significant limitation in quality of life. She had received treatment with levodopa/carbidopa, which she discontinued due to nausea and pruritus, subsequently she received rotigotine and rasagiline without control of the tremor. It was decided by the neurosurgical board and ethics committee at the international FOSCAL clinic to perform a unilateral RF subthalamotomy (2 lesions at 75°C, for 60 seconds).
Tremor was measured by an original computational method, measuring a set of motion trajectories calculated using video. The trajectories were characterized by a set of kinematics, which with a statistical analysis allowed the tremor to be quantified. Additionally, she was followed up with part 3.16 of the UPDRS, the quality of life questionnaire (PDQ-39) and the Fahn-Tolosa tremor scale before and six months after the procedure.
Results: There were no complications. The tremor was stopped intraoperatively and this benefit was maintained until the last visit. Scores on UPDRS-3.16 decreased by 47.6%, on the FahnTolosa tremor scale by 60%, and a concomitant improvement in quality of life with the PDQ-39 questionnaire was also observed by 66%.
Discussion: RF ablative techniques still represent an excellent therapeutic option in properly selected cases. Quantification of tremor before and after surgery objectively demonstrates adequate tremor control and should always be documented.
Conclusions: RF subthalamotomy provided significant control of tremor and rigidity, significantly improving the quality of life of an 83-year-old patient who, due to her nutritional status, was not a candidate for Deep Brain Stimulation (DBS) due to risk of brain exposure. system. The application of new quantitative technologies allows a precise evaluation of results. We consider the computational method for tremor evaluation as a safe and effective alternative in quantification from trajectories before and after RF subthalamotomy.