# Rescue Thalamotomy for Habituation to Deep Brain Stimulation in Essential Tremor: Case Report

## TL;DR

This case report describes a successful treatment for a patient who lost benefit from deep brain stimulation for essential tremor.

## Contribution

The first reported case of thalamotomy used to address habituation to posterior subthalamic area DBS in essential tremor.

## Key findings

- A patient with essential tremor experienced symptom recurrence after three months of DBS.
- Left-sided Vim thalamotomy led to tremor control after a 1.5-month delay.
- The study discusses mechanisms of habituation and lesion-induced tremor suppression.

## Abstract

Habituation to deep brain stimulation (DBS) remains a therapeutic challenge in essential tremor (ET), with 4–42% of patients experiencing progressive loss of benefit.

A 68-year-old man with ET presented with debilitating bilateral tremor. The patient underwent bilateral DBS to posterior subthalamic area (PSA). Despite initial tremor relief, symptoms gradually recurred three months later. After 12 months of unsuccessful programming, the patient underwent left-sided radiofrequency Vim thalamotomy. Due to severe tremor rebound phenomenon, tremor control was achieved in 1.5 months.

To our knowledge, this study represents the first report of successful thalamotomy performed for PSA-DBS habituation, accompanied by delayed postoperative tremor improvement. The clinical trajectory and putative mechanisms underlying both habituation and lesion-induced tremor suppression are discussed based on imaging analysis.