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Object: We present four cases where supplementary "rescue" deep brain stimulation (DBS) leads were added for patients who failed to obtain anticipated clinical benefits., Methods: Nine patients out of 295 patients who underwent DBS between 2002 and 2009, were identified as rescue lead recipients. Of these nine cases, four cases were evaluated. Two had medication refractory tremor which was incompletely suppressed by Vim (nucleus ventralis intermedius) thalamic DBS, and supplemental rescue leads were implanted in either the VO (ventral oralis) thalamic nucleus or the STN (subthalamic nucleus). The remaining two cases were patients with severe dystonia who were initially treated with bilateral GPi (globus pallidus internus)-DBS, and following suboptimal clinical benefits, a second GPi rescue lead was added in a case, and bilateral STN rescue leads were added in the other case. Outcomes of scores collected included Fahn-Tolosa-Marin Tremor Rating Scale (TRS) for tremor cases and the Unified Dystonia Rating Scale (UDRS) for dystonia cases and the symptom specific patient global impression scales (PGIS; 7 point scale)., Results: In the tremor cases, the TRS scale improved by 34.1 ± 7.4% and the PGIS following rescue lead was "minimally improved" to "very much improved" (range 1-2). In dystonia cases, the UDRS improved by 50.0 ± 23.6% and the PGIS was "minimally improved" to "very much improved" (range 1-2) after rescue lead surgery., Conclusion: This small retrospective case series demonstrated that, in appropriately selected patients with suboptimal results of standard DBS therapy, the addition of rescue lead(s) may provide meaningful clinical benefit., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Holmes' tremor is a rare symptom characterized by a complex combination of resting, postural and intention tremor. A 66-year-old right-handed man post-traumatically developed severe action tremor in his right hand, which had a component of the re-emergent type and predominantly involved proximal muscles. He also presented mild resting tremor in his right hand. As the response of levodopa/carbidopa and arotinolol was limited, he started zonisamide, which resulted in dramatic improvement. The Fahn-Tolosa-Marin Tremor Rating Scale motor score improved from 52 points to 24 points. In conclusion, zonisamide could be a therapeutic option for post-traumatic Holmes' tremor. Further prospective studies are required. [ABSTRACT FROM AUTHOR]